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Walach MT, Schiefelbein F, Schneller A, Schoen G, von Klot CA, Katzendorn O, Mühlbauer J, Nuhn P, Kriegmair MC, Harke NN. Perinephric Toxic Fat: Impact on Surgical Complexity, Perioperative Outcome, and Surgical Approach in Partial Nephrectomy. Urol Int 2023; 107:126-133. [PMID: 36423583 PMCID: PMC9945181 DOI: 10.1159/000527090] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 09/09/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION To assess influencing factors on perinephric toxic fat (high Mayo Adhesive Probability [MAP] score) and the impact of high MAP scores on surgical complexity, perioperative outcome, and surgical approach in patients with localized renal tumors undergoing open (OPN) and robot-assisted partial nephrectomy (RAPN). METHODS 698 patients were included in this study. Based on preoperative imaging, adherent perinephric fat (APF) was assessed to define MAP scores. Regression analyses assessed influencing parameters for high MAP scores (≥3), predictors of surgical outcome, and influencing factors on surgical approach. RESULTS OPN was performed in 331 (47%) patients, and 367 (53%) patients underwent RAPN. Male gender (p < 0.001), age ≥65 (p < 0.001), and BMI ≥27.4 kg/m2 (p < 0.001) showed to be significantly influencing factors for the presence of APF. High MAP scores showed to be an influencing factor for a prolonged surgery duration (OR = 1.68, 95% CI 1.22-2.31, p = 0.002) and a significant predictor to rather undergo OPN than RAPN (OR = 1.5, 95% CI 1.05-2.15, p = 0.027). CONCLUSION Older, male patients with high BMI scores have a higher risk for APF. The presence of APF increases surgery time and may have an impact on decision making regarding the preferred surgical approach.
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Affiliation(s)
- Margarete Teresa Walach
- Department of Urology and Urologic Surgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany,*Margarete Teresa Walach,
| | - Frank Schiefelbein
- Department of Urology, Klinikum Wuerzburg Mitte − Missioklinik, Wuerzburg, Germany
| | - Andreas Schneller
- Department of Urology, Klinikum Wuerzburg Mitte − Missioklinik, Wuerzburg, Germany
| | - Georg Schoen
- Department of Urology, Urological Clinic Muenchen − Planegg, Planegg, Germany
| | | | - Olga Katzendorn
- Department of Urology and Urologic Oncology, Hannover Medical School, Hannover, Germany
| | - Julia Mühlbauer
- Department of Urology and Urologic Surgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Philipp Nuhn
- Department of Urology and Urologic Surgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Maximilian Christian Kriegmair
- Department of Urology and Urologic Surgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Nina Natascha Harke
- Department of Urology and Urologic Oncology, Hannover Medical School, Hannover, Germany
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Harke NN, Kuczyk MA, Huusmann S, Schiefelbein F, Schneller A, Schoen G, Wiesinger C, Pfuner J, Ubrig B, Gloger S, Osmonov D, Eraky A, Witt JH, Liakos N, Wagner C, Hadaschik BA, Radtke JP, Al Nader M, Imkamp F, Siemer S, Stöckle M, Zeuschner P. Impact of Surgical Experience Before Robot-assisted Partial Nephrectomy on Surgical Outcomes: A Multicenter Analysis of 2500 Patients. EUR UROL SUPPL 2022; 46:45-52. [PMID: 36506259 PMCID: PMC9732453 DOI: 10.1016/j.euros.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2022] [Indexed: 11/07/2022] Open
Abstract
Background Robot-assisted partial nephrectomy (RAPN) is a challenging procedure that is influenced by a multitude of factors. Objective To assess the impact of prior surgical experience on perioperative outcomes in RAPN. Design setting and participants In this retrospective multicenter study, results for 2548 RAPNs performed by 25 surgeons at eight robotic referral centers were analyzed. Perioperative data for all consecutive RAPNs from the start of each individual surgeon's experience were collected, as well as the number of prior open or laparoscopic kidney surgeries, pelvic surgeries (open, laparoscopic, robotic), and other robotic interventions. Intervention Transperitoneal or retroperitoneal RAPN. Outcome measurements and statistical analysis The impact of prior surgical experience on operative time, warm ischemia time (WIT), major complications, and margin, ischemia, complication (MIC) score (negative surgical margins, WIT ≤20 min, no major complications) was assessed via univariate and multivariable regression analyses accounting for age, gender, body mass index (BMI), American Society of Anesthesiologists score, PADUA score, and RAPN experience. Results and limitations BMI, PADUA score, and surgical experience in RAPN had a strong impact on perioperative outcomes. A plateau effect for the learning curve was not observed. Prior laparoscopic kidney surgery significantly reduced the operative time (p < 0.001) and WIT (p < 0.001) and improved the MIC rate (p = 0.022). A greater number of prior robotic pelvic interventions decreased WIT (p = 0.011) and the rate of major complications (p < 0.001) and increased the MIC rate (p = 0.011), while prior experience in open kidney surgery did not. One limitation is the short-term follow-up. Conclusions Mastering of RAPN is an ongoing learning process. However, prior experience in laparoscopic kidney and robot-assisted pelvic surgery seems to improve perioperative outcomes for surgeons when starting with RAPN, while experience in open surgery might not be crucial. Patient summary In this multicenter analysis, we found that a high degree of experience in keyhole kidney surgery and robot-assisted pelvic surgery helps surgeons in achieving good initial outcomes when starting robot-assisted kidney surgery.
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Affiliation(s)
- Nina N. Harke
- Department of Urology, Hannover Medical School, Hannover, Germany,Corresponding author. Department of Urology and Urologic Oncology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany. Tel. +49 511 532 5847; Fax +49 511 532 5634.
| | - Markus A. Kuczyk
- Department of Urology, Hannover Medical School, Hannover, Germany
| | - Stephan Huusmann
- Department of Urology, Hannover Medical School, Hannover, Germany
| | - Frank Schiefelbein
- Department of Urology, Klinikum Wuerzburg Mitte-Missioklinik, Wuerzburg, Germany
| | - Andreas Schneller
- Department of Urology, Klinikum Wuerzburg Mitte-Missioklinik, Wuerzburg, Germany
| | - Georg Schoen
- Department of Urology, Urologische Klinik Muenchen-Planegg, Planegg, Germany
| | - Clemens Wiesinger
- Department of Urology, Klinikum Wels-Grieskirchen GmbH, Wels, Austria
| | - Jacob Pfuner
- Department of Urology, Klinikum Wels-Grieskirchen GmbH, Wels, Austria
| | - Burkhard Ubrig
- Department of Urology, Augusta-Kranken-Anstalt Bochum, Bochum, Germany
| | - Simon Gloger
- Department of Urology, Augusta-Kranken-Anstalt Bochum, Bochum, Germany
| | - Daniar Osmonov
- Department of Urology, University of Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Ahmed Eraky
- Department of Urology, University of Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Jörn H. Witt
- Department of Urology, St. Antonius Hospital Gronau, Gronau, Germany
| | - Nikolaos Liakos
- Department of Urology, St. Antonius Hospital Gronau, Gronau, Germany
| | - Christian Wagner
- Department of Urology, St. Antonius Hospital Gronau, Gronau, Germany
| | | | | | - Mulham Al Nader
- Department of Urology, University Hospital Essen, Essen, Germany
| | - Florian Imkamp
- Department of Urology, Vinzenzkrankenhaus Hannover, Hannover, Germany
| | - Stefan Siemer
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany
| | - Michael Stöckle
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany
| | - Philip Zeuschner
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany
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Schoen G. Roboterassistierte organerhaltende Nierentumorchirurgie. Aktuelle Urol 2022; 53:188-200. [PMID: 35345015 DOI: 10.1055/a-1696-8097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Walach M, Schiefelbein F, Schneller A, Schoen G, Von Klot C, Mühlbauer J, Nuhn P, Kriegmair M, Harke N. Perinephric toxic fat: Impact on surgical complexity, perioperative outcome and surgical approach in partial nephrectomy. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00297-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Harke N, Schiefelbein F, Schneller A, Schoen G, Wiesinger C, Pfuner J, Falkensammer E, Gilbert N, Eraky A, Zimmermanns V, Paramythelli I, Hadaschik B, Radtke J, Darr C, Kriegmair M, Flintrop M, Wolters M, Faraj Tabrizi P, Kuczyk M, Osmonov D. Robot-assisted partial nephrectomy for multiple renal tumors – a multicenter analysis. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00437-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Maas KJ, Warncke M, Behzadi C, Welsch GH, Schoen G, Kaul MG, Adam G, Bannas P, Henes FO. Correlation of T2* relaxation times of the retropatellar cartilage with tibial tuberosity-trochlea groove distance in professional soccer players. Sci Rep 2020; 10:15355. [PMID: 32948810 PMCID: PMC7501245 DOI: 10.1038/s41598-020-72299-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 08/26/2020] [Indexed: 12/14/2022] Open
Abstract
The tibial tuberosity–trochlear groove (TT–TG) distance is a radiographic measurement that is used to quantify malalignment of the patellofemoral joint (PFJ) in cross-sectional imaging. There is an ongoing debate about the impact of the TT–TG-distance on lateral patellar instability and the initiating of cartilage degeneration. In this prospective study, the association of T2* relaxation times and TT–TG distances in professional soccer players was analyzed. 36 knees of 18 professional soccer players (age: 21 ± 2.8 years) were evaluated. Participants underwent knee MRI at 3 T. For qualitative image analysis, fat-saturated 2D PD-weighted Fast Spin Echo (FSE) and T1-weighted FSE sequences were used. For quantitative analysis, T2* measurements in 3D data acquisitions were performed. In a qualitative analysis there was no structural cartilage damage and no abnormalities of the patellar and trochlea shape. The highest T2* values (26.7 ± 5.9 ms) were observed in the central compartment of the patella. The mean TT–TG distance was 10 ± 4 mm (range 3–20 mm). There was no significant correlation between TT–TG distance and T2* relaxation times in all three compartments of the retropatellar cartilage. Our study shows that so long as patellar and trochlear morphology is normal, TT–TG distance alone does not affect the tissue structure of the retropatellar cartilage in professional soccer players.
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Affiliation(s)
- Kai-Jonathan Maas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Center for Radiology and Endoscopy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - M Warncke
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Center for Radiology and Endoscopy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - C Behzadi
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Center for Radiology and Endoscopy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - G H Welsch
- UKE Athleticum-Center for Athletic Medicine, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - G Schoen
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - M G Kaul
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Center for Radiology and Endoscopy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - G Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Center for Radiology and Endoscopy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - P Bannas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Center for Radiology and Endoscopy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - F O Henes
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Center for Radiology and Endoscopy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
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Harke NN, Darr C, Radtke JP, von Ostau N, Schiefelbein F, Eraky A, Hamann C, Szarvas T, Hadaschik BA, Tropmann-Frick M, Juenemann KP, Schoen G, Osmonov D. Retroperitoneal Versus Transperitoneal Robotic Partial Nephrectomy: A Multicenter Matched-pair Analysis. Eur Urol Focus 2020; 7:1363-1370. [PMID: 32912841 DOI: 10.1016/j.euf.2020.08.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/10/2020] [Accepted: 08/27/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND With increasing acceptance of robotic partial nephrectomy over the last decade, there is an ongoing discussion about the transperitoneal versus retroperitoneal access. OBJECTIVE To report outcomes after transperitoneal (TRPN) versus retroperitoneal (RRPN) robotic partial nephrectomy. DESIGN, SETTING, AND PARTICIPANTS A total of 754 patients were identified from the databases of three high-volume centers who underwent either TRPN (n = 551) or RRPN (n = 203). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Perioperative data were evaluated retrospectively. A propensity score matched-pair analysis was performed with the following variables: grade of renal insufficiency, age, body mass index, tumor diameter, and preoperative aspects and dimensions used for an anatomical (PADUA) score with a subsequent subgroup analysis for tumor location. For quality outcomes, the margin, ischemia, and complications (MIC) criteria were used (negative margins, ischemia time <20 min, and no major complications). Statistical analyses included chi-square and Mann-Whitney U tests. RESULTS AND LIMITATIONS In all, 176 patients could be matched in each group. The median tumor diameter was 28 mm with a PADUA score of 9. In 11% of RRPN versus 44% of TRPN cases, an anterior tumor location was found, and in 55% versus 30%, a posterior lesion was found (p < 0.001). Operative time (119 vs 139 min, p < 0.001) and warm ischemia time (9 vs 10 min, p = 0.003) were significantly shorter for RRPN. No significant differences were observed between intra- and postoperative complication rates, with 8% major complications in TRPN versus 3% in RRPN (p = 0.06). The MIC criteria were achieved in 90% in the RRPN versus 88% in the TRPN group, without differences for tumor location. CONCLUSIONS Significant differences between TRPN and RRPN could be found for intraoperative time, while complication rates and quality outcomes were comparable. RRPN can also be a considerable alternative for anterior tumors. PATIENT SUMMARY In this study, we demonstrate that robotic partial nephrectomy is feasible with either a transperitoneal or a retroperitoneal surgical access. The posterior approach can also be used for anterior renal tumors and may result in shorter operative time.
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Affiliation(s)
- Nina N Harke
- Department of Urology, University Hospital Essen, Essen, Germany.
| | - Christopher Darr
- Department of Urology, University Hospital Essen, Essen, Germany
| | | | - Nicola von Ostau
- Department of Urology, University Hospital Essen, Essen, Germany
| | | | - Ahmed Eraky
- Department of Urology, University of Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Claudius Hamann
- Department of Urology, University of Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Tibor Szarvas
- Department of Urology, University Hospital Essen, Essen, Germany; Department of Urology, Semmelweis University, Budapest, Hungary
| | | | | | | | - Georg Schoen
- Department of Urology, Missioklinik, Wuerzburg, Germany; Department of Urology, Urologische Klinik Muenchen-Planegg, Planegg, Germany
| | - Daniar Osmonov
- Department of Urology, University of Schleswig-Holstein Campus Kiel, Kiel, Germany
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Schaefer A, Sarwari H, Deuschl F, Schirmer J, Schofer N, Schneeberger Y, Schoen G, Blankenberg S, Reichenspurner H, Schäfer U, Conradi L. Transcatheter Aortic Valve Implantation in Patients with Mitral Annular Calcification or Mitral Stenosis: Analysis of Acute Hemodynamic Changes and Acute and Long-Term Outcomes. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- A. Schaefer
- University Heart Center Hamburg, Hamburg, Germany
| | - H. Sarwari
- University Heart Center Hamburg, Hamburg, Germany
| | - F. Deuschl
- University Heart Center Hamburg, Hamburg, Germany
| | - J. Schirmer
- University Heart Center Hamburg, Hamburg, Germany
| | - N. Schofer
- University Heart Center Hamburg, Hamburg, Germany
| | | | - G. Schoen
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - U. Schäfer
- University Heart Center Hamburg, Hamburg, Germany
| | - L. Conradi
- University Heart Center Hamburg, Hamburg, Germany
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Harke NN, Mandel P, Witt JH, Wagner C, Panic A, Boy A, Roosen A, Ubrig B, Schneller A, Schiefelbein F, Wagener N, Honeck P, Schoen G, Hadaschik B, Michel MS, Kriegmair MC. Are there limits of robotic partial nephrectomy? TRIFECTA outcomes of open and robotic partial nephrectomy for completely endophytic renal tumors. J Surg Oncol 2018; 118:206-211. [PMID: 29878367 DOI: 10.1002/jso.25103] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 04/23/2018] [Indexed: 11/05/2022]
Abstract
BACKGROUND To compare the outcomes of robot-assisted (RAPN) and open partial nephrectomy (OPN) for completely endophytic renal tumors. METHODS Consecutive patients undergoing OPN or RAPN for entirely endophytic tumors in four high-volume centers between 2008 and 2016 were identified. Endophytic masses were identified based on sectional imaging. Patient characteristics and surgical outcome were compared using Mann-Whitney-U-test and chi-squared-tests. Uni- and multivariate analyses were performed to identify predictors of TRIFECTA achievement and excisional volume loss. RESULTS Out of 1128 patients, 10.9% (64) of RAPN and 13.9% (76) of OPN underwent surgery for entirely endophytic tumors. Operative time was longer for RAPN (169 vs 140 min, P = 0.03) while ischemia time was shorter (13 vs 18 min, P = 0.001). Complication rates were comparable (21% OPN vs 22% RAPN, P = 0.91) and TRIFECTA achievement was not different between the groups (68% OPN vs 75% RAPN, P = 0.39). In multivariate analyses type of surgery was not associated with TRIFECTA achievement or excisional volume loss. Here, only tumor complexity (OR 0.48, P = 0.001) and size (OR 1.01, P = 0.002) were independent predictors. CONCLUSION For entirely endophytic tumors, both RAPN and OPN offer good TRIFECTA achievement. This encourages the use of NSS even for these highly complex tumors using the surgeon's preferred approach.
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Affiliation(s)
- Nina N Harke
- Essen University Hospital, Urology, Essen, Germany
| | - Philipp Mandel
- University Hospital Frankfurt, Urology, Frankfurt, Germany
| | - Jorn H Witt
- St. Antonius-Hospital, Urology, Gronau, Germany
| | | | - Andrej Panic
- Essen University Hospital, Urology, Essen, Germany
| | - Anselm Boy
- Witten/Herdecke University, Urology, Bochum, Germany
| | | | | | | | | | - Nina Wagener
- University Medical Center Mannheim, Urology, Mannheim, Germany
| | - Patrick Honeck
- University Medical Center Mannheim, Urology, Mannheim, Germany
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Ubrig B, Roosen A, Wagner C, Trabs G, Schiefelbein F, Witt JH, Schoen G, Harke NN. Tumor complexity and the impact on MIC and trifecta in robot-assisted partial nephrectomy: a multi-center study of over 500 cases. World J Urol 2018; 36:783-788. [DOI: 10.1007/s00345-018-2191-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 01/19/2018] [Indexed: 01/20/2023] Open
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11
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Schneeberger Y, Schäfer A, Gulbins H, Reiter B, Sill B, Schoen G, Geronne P, Bernhard M, Reichenspurner H. Surgeons' Experience in Off-Pump Coronary Artery Bypass Grafting: Is There a Difference in the Acute 30-Day Outcome. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1628019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Y. Schneeberger
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - A. Schäfer
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - H. Gulbins
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - B. Reiter
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - B. Sill
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - G. Schoen
- Department of Medical Biometry and Epidemiology, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - P. Geronne
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - M. Bernhard
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - H. Reichenspurner
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
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Spink C, Avanesov M, Schmidt T, Grass M, Schoen G, Adam G, Koops A, Ittrich H, Bannas P. Noise reduction angiographic imaging technology reduces radiation dose during bronchial artery embolization. Eur J Radiol 2017; 97:115-118. [PMID: 29153361 DOI: 10.1016/j.ejrad.2017.10.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 10/25/2017] [Accepted: 10/30/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Comparison of radiation doses in patients undergoing angiographic bronchial artery embolization (BAE) before and after a noise reduction imaging technology upgrade. METHODS We performed a retrospective study of 70 patients undergoing BAE. Procedures were performed before (n=32) and after (n=38) the technology upgrade containing additional filters and improved image-processing. Cumulative air kerma (AK), cumulative dose area product (DAP), number of exposure frames, total fluoroscopy time and amount of contrast agent were recorded. Mean values were calculated and compared using two-tailed t-tests. DSA image quality was assessed independently by two blinded readers and compared using the Wilcoxon signed-rank test. RESULTS Using the new technology resulted in a significant reduction of 59% in DAP (149.2 (103.1-279.1) vs. 54.8 (38.2-100.7) Gy*cm2, p<0.001) and a significant reduction of 60% for AK (1.3 (0.6-1.9) vs. 0.5 (0.3-0.9) Gy, p<0.001) in comparison to procedures before the upgrade. There was no significant difference between the number of exposure frames in both groups (251±181 vs. 254±133 frames, p=0.07), time of fluoroscopy (28.8 (18.5-50.4) vs. 28.1 (23.3-38.7) min, p=0.73), or the amount of contrast agent used (139.5±70.8 vs. 163.1±63.1ml, p=0.11). No significant difference regarding image quality could be detected (3 (2,3) vs. 3 (2-4), p=0.64). CONCLUSIONS The new angiographic noise reduction technology significantly decreases the radiation dose during bronchial artery embolization without compromising image quality or increasing time of fluoroscopy or contrast volume.
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Affiliation(s)
- C Spink
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - M Avanesov
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - T Schmidt
- Philips Healthcare, Hamburg, Germany
| | - M Grass
- Philips Healthcare, Hamburg, Germany
| | - G Schoen
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - G Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Koops
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - H Ittrich
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - P Bannas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Harke N, Wagner C, Roosen A, Schiefelbein F, Ubrig B, Schoen G, Witt JH. PD20-10 DOES TUMOR COMPLEXITY HAVE AN IMPACT ON MIC AND TRIFECTA OUTCOME IN ROBOT-ASSISTED PARTIAL NEPHRECTOMY? A MULTI-CENTER STUDY OF OVER 500 CASES. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Schaefer A, Dickow J, Schoen G, Westhofen S, Al-Saydali T, Kloss L, Reichenspurner H, Detter C. Aortic Valve Replacement for Infective Endocarditis: Case Matched Comparison of a Stentless Bovine Pericardial Aortic Valve vs. A Stented Bovine Pericardial Valve. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- A. Schaefer
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - J. Dickow
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - G. Schoen
- Department of Medical Biometry and Epidemiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - S. Westhofen
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - T. Al-Saydali
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - L. Kloss
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - H. Reichenspurner
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - C. Detter
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
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Spink C, Avanesov M, Schmidt T, Grass M, Schoen G, Adam G, Bannas P, Koops A. Radiation dose reduction during transjugular intrahepatic portosystemic shunt implantation using a new imaging technology. Eur J Radiol 2016; 86:284-288. [PMID: 28027761 DOI: 10.1016/j.ejrad.2016.11.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 11/15/2016] [Accepted: 11/23/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To compare patient radiation dose in patients undergoing transjugular intrahepatic portosystemic shunt (TIPS) implantation before and after an imaging-processing technology upgrade. METHODS In our retrospective single-center-study, cumulative air kerma (AK), cumulative dose area product (DAP), total fluoroscopy time and contrast agent were collected from an age- and BMI-matched collective of 108 patients undergoing TIPS implantation. 54 procedures were performed before and 54 after the technology upgrade. Mean values were calculated and compared using two-tailed t-tests. Two blinded, independent readers assessed DSA image quality using a four-rank likert scale and the Wilcoxcon test. RESULTS The new technology demonstrated a significant reduction of 57% of mean DAP (402.8 vs. 173.3Gycm2, p<0.001) and a significant reduction of 58% of mean AK (1.7 vs. 0.7Gy, p<0.001) compared to the precursor technology. Time of fluoroscopy (26.4 vs. 27.8min, p=0.45) and amount of contrast agent (109.4 vs. 114.9ml, p=0.62) did not differ significantly between the two groups. The DSA image quality of the new technology was not inferior (2.66 vs. 2.77, p=0.56). CONCLUSIONS In our study the new imaging technology halved radiation dose in patients undergoing TIPS maintaining sufficient image quality without a significant increase in radiation time or contrast consumption.
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Affiliation(s)
- C Spink
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - M Avanesov
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - T Schmidt
- Philips Healthcare, Hamburg, Germany
| | - M Grass
- Philips Research, Hamburg, Germany
| | - G Schoen
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - G Adam
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - P Bannas
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Koops
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Behzadi C, Welsch GH, Laqmani A, Henes FO, Kaul MG, Schoen G, Adam G, Regier M. Comparison of T2* relaxation times of articular cartilage of the knee in elite professional football players and age-and BMI-matched amateur athletes. Eur J Radiol 2016; 86:105-111. [PMID: 28027735 DOI: 10.1016/j.ejrad.2016.10.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 09/26/2016] [Accepted: 10/26/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Recent investigation has underlined the potential of quantitative MR imaging to be used as a complementary tool for the diagnosis of cartilage degeneration at an early state. The presented study analyses T2* relaxation times of articular cartilage of the knee in professional athletes and compares the results to age- and BMI (Body Mass Index)-matched healthy amateur athletes. MATERIALS AND METHODS 22 professional football players and 22 age- and BMI-matched individuals were underwent knee Magnetic Resonance Imaging (MRI) at 3T including qualitative and quantitative analysis. Qualitative analysis included e.g. meniscal tears, joint effusion and bone edema. For quantitative analysis T2* (22 ET: 4.6-53.6ms) measurements in 3D data acquisition were performed. Deep and superficial layers of 22 predefined cartilage segments were analysed. All data sets were postprocessed using a dedicated software tool. Statistical analysis included Student t-test, confidence intervals and a random effects model. RESULTS In both groups, T2* relaxation times were significantly higher in the superficial compared to the deep layers (p<0.001). Professional athletes had significantly higher relaxation times in eight superficial and three deep cartilage layers in the predefined cartilage segments (p<0.05). Highly significant differences were found in the weight-bearing segments of the lateral superficial femoral condyle (p<0.001). CONCLUSION Elevated T2* values in cartilage layers of professional football players compared to amateur athletes were noted. The effects seem to predominate in superficial cartilage layers.
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Affiliation(s)
- C Behzadi
- Department of Diagnostic and Interventional Radiology and Nuclearmedicine, University Medical Center Hamburg-Eppendorf, Hamburg, 20246, Germany.
| | - G H Welsch
- Department of Sports Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, 20246, Germany
| | - A Laqmani
- Department of Diagnostic and Interventional Radiology and Nuclearmedicine, University Medical Center Hamburg-Eppendorf, Hamburg, 20246, Germany
| | - F O Henes
- Department of Diagnostic and Interventional Radiology and Nuclearmedicine, University Medical Center Hamburg-Eppendorf, Hamburg, 20246, Germany
| | - M G Kaul
- Department of Diagnostic and Interventional Radiology and Nuclearmedicine, University Medical Center Hamburg-Eppendorf, Hamburg, 20246, Germany
| | - G Schoen
- Department of Medical Biometry and Epidemiology, University Medical Center, Hamburg-Eppendorf, Hamburg, 20246, Germany
| | - G Adam
- Department of Diagnostic and Interventional Radiology and Nuclearmedicine, University Medical Center Hamburg-Eppendorf, Hamburg, 20246, Germany
| | - M Regier
- Department of Diagnostic and Interventional Radiology and Nuclearmedicine, University Medical Center Hamburg-Eppendorf, Hamburg, 20246, Germany
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Linder M, Seiffert M, Schofer N, Deuschl F, Schoen G, Schirmer J, Treede H, Blankenberg S, Reichenspurner H, Schaefer U, Conradi L. Device Landing Zone Calcification and Its Impact on Post Procedural Paravalvular Leakage after Transcatheter Aortic Valve Implantation with Two Generations of Balloon-expandable Transcatheter Heart Valves. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Harke N, Schoen G, Schiefelbein F, Heinrich E. Selective clamping under the usage of near-infrared fluorescence imaging with indocyanine green in robot-assisted partial nephrectomy: a single-surgeon matched-pair study. World J Urol 2013; 32:1259-65. [PMID: 24193104 DOI: 10.1007/s00345-013-1202-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Accepted: 10/23/2013] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To present a single-surgeon matched-pair analysis to show the feasibility of combining the technique of selective clamping with usage of near-infrared fluorescence imaging in robot-assisted partial nephrectomy and to investigate short-term renal function outcomes. METHODS Twenty-two patients underwent selective clamping partial nephrectomy with the application of indocyanine green (ICG). Out of this cohort, a matched-pair analysis for R.E.N.A.L. nephrometry parameter was employed for 15 exactly matching partners. Demographic, surgical, pathological and kidney function data were collected for the initial cohort, and matched-pair comparison was made between the subgroups retrospectively. RESULTS Robot-assisted partial nephrectomy without clamping of the hilum was possible in 21 patients; in one patient, main artery clamping was necessary due to bleeding. Mean clinical tumor size was 37.7 mm. Mean selective clamping ischemia time was 11.6 min with an estimated blood loss of 347 ml. No intraoperative complications occurred, and postoperative complications (n = 4), including two major urological (urinoma, late-onset acute hemorrhage) complications, were found. There were no side effects of ICG administration. Matched-pair analysis for 15 patients showed similar demographic and surgical data without any significant differences in tumor characteristics. Comparing short-term renal function outcomes, significantly decreased estimated glomerular filtration rate reduction in the selective clamping group with an absolute loss of 5.1 versus 16.1 ml/min in the global ischemia cohort (p = 0.045) could be observed. CONCLUSIONS Robot-assisted partial nephrectomy with selective clamping of the tumor feeding vascular branches is a promising technique for reduced ischemic renal trauma. This may lead to improved kidney function preservation.
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Affiliation(s)
- Nina Harke
- Department of Urology, Missionsaerztliche Klinik, Salvatorstr. 7, 97074, Würzburg, Germany,
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Schiefelbein F, Harke N, Noe M, Schoen G. 353 ROBOT-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY (RARP)- ANASTOMOSIS TECHNIQUE WITHOUT POSTOPERATIVE URETHRAL CATHETER. J Urol 2013. [DOI: 10.1016/j.juro.2013.02.1740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Heinrich E, Ferber A, Schoen G, Schiefelbein F, Trojan L, Egner T. MP-13.05 Five Years' Experience with High-Intensity Focused Ultrasonography for Prostate Cancer Treatment: A Mid-Term Follow Up. Urology 2011. [DOI: 10.1016/j.urology.2011.07.304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Schiefelbein F, Noe M, Remmert H, Schoen G. V369 PROSTATE VAPORIZATION WITH THE 180-WATT GREENLIGHT XPS LASER. J Urol 2011. [DOI: 10.1016/j.juro.2011.02.456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Schoen G, Harke N, Egner T, Schiefelbein F. V1695 POST-CHEMOTHERAPY ROBOT-ASSISTED LAPAROSCOPIC RESECTION OF A RESIDUAL RETROPERITONEAL TUMOR IN TESTICULAR CANCER. J Urol 2010. [DOI: 10.1016/j.juro.2010.02.1541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Heinrich E, Gattenloehner S, Mueller-Hermelink HK, Michel MS, Schoen G. Paraganglioma of urinary bladder. Urol J 2008; 5:57-59. [PMID: 18454430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Elmar Heinrich
- Department of Urology, Missionsaerztliche Klinik Wuerzburg, Wuerzburg, Germany.
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Heinrich E, Schiefelbein F, Schoen G. Technique and short-term outcome of green light laser (KTP, 80W) vaporisation of the prostate. Eur Urol 2007; 52:1632-7. [PMID: 17689002 DOI: 10.1016/j.eururo.2007.07.033] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2007] [Accepted: 07/23/2007] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Photoselective laser vaporisation prostatectomy with an 80-W potassium-titanyl-phosphate (KTP) laser is an effective procedure for men with symptomatic benign prostatic hyperplasia. The main advantages of the laser treatment are less blood loss and the short hospital stay. METHODS The DVD and photos show the main steps and difficulties of the procedure. All patients were evaluated preoperatively and postoperatively by using the International Prostate Symptom Score, volume of prostate, maximum flow rate, haemoglobin values, and postmicturition volume of residual urine. Days of bladder catheterisation, duration of the procedure, and prostate-specific antigen values were determined as well. RESULTS The results in 140 patients, who underwent KTP laser treatment, were evaluated. The mean age of the patients was 69+/-7.8 yr. Mean volume of prostates, mean operative time, and mean energy delivery were 43+/-22 ml, 53+/-16 min, and 181+/-58 kJ, respectively. The bladder catheter was removed usually on the first postoperative day. Preoperative haemoglobin values were just slightly higher at 14.4+/-1.3g/dl compared to the postoperative values of 13.9+/-1.4 g/dl. The most common complication, dysuria, was seen in 35 patients (25%), followed by mild haematuria in 21 patients (15%). CONCLUSIONS Photoselective laser vaporisation of the prostate is a treatment option in men who are at high risk for clinically significant bleeding. The procedure provides a high level of intraoperative and postoperative safety and seems to be comparable to transurethral resection of the prostate in the relief of obstructive symptoms.
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Affiliation(s)
- Elmar Heinrich
- Department of Urology, Missionsärztliche Klinik Würzburg, Würzburg, Germany.
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Abstract
OBJECTIVE Recently, minimally invasive therapies for renal cell carcinoma have been devised to minimise operative morbidity yet achieve comparable oncologic and functional outcomes. This video summary of laparoscopic transperitoneal organ-preserving kidney cancer resection shows the procedure from the surgeon's view. METHODS The video and photos show the main steps of the procedure. The results of 40 transperitoneal and retroperitoneal procedures performed during 2001-2005 are discussed. Preoperative preparation includes abdominal computed tomography and ureteral catheterisation. Tumour margins were determined by laparoscopic renal ultrasonography. Vessel control was done by en bloc clamping or solitary clamping of the artery. For optimal macroscopic evaluation of the resection margins, tumour excision was solely done with cold Endoshears followed by pelvicaliceal suture repair and parenchymal closure over surgical bolsters with a biologic haemostatic agent. RESULTS In 40 cases, we converted to the open procedure only once. The average patients age was 53 yr and mean tumour size was 26 mm. No patient showed positive surgical margins. The mean warm ischemia time was 21 min. Final histopathology revealed renal clear cell carcinoma as the major cell type followed by papillary renal carcinoma. Two patients required blood transfusion. Estimated mean blood loss was 270 ml. Median time of hospitalisation was 6 d. CONCLUSION Endoscopic partial nephrectomy can be performed by experienced surgeons in selected patients. Tumour location and size and the surgeons' experience and preference are the main parameters to make the decision of the type of access.
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Affiliation(s)
- Elmar Heinrich
- Department of Urology, Missionsärztliche Klinik Würzburg, Germany
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Schnell R, Katouzi AA, Linnartz C, Schoen G, Drillich S, Hansmann ML, Schiefer D, Barth S, Zangemeister-Wittke U, Stahel RA, Diehl V, Engert A. Potent anti-tumor effects of an anti-CD24 ricin A-chain immunotoxin in vitro and in a disseminated human Burkitt's lymphoma model in SCID mice. Int J Cancer 1996; 66:526-31. [PMID: 8635869 DOI: 10.1002/(sici)1097-0215(19960516)66:4<526::aid-ijc17>3.0.co;2-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A new anti-CD24 immunotoxin (IT), SWA11.dgA, was constructed by coupling the MAb SWA11 via the bivalent linker SMPT to deglycosylated ricin A-chain (dgA). The effects of SWA11.dgA were evaluated in vitro against the B-precursor leukemia cell line REH, the non-B-non-T acute lymphoblastic leukemia cell line NALM-6 and the Burkitt's lymphoma cell lines BL-2 and BL-38. Binding of SWA11 to the CD24 antigen was assessed by flow cytometry demonstrating high affinity of the MAb for all cell lines tested. SWA11.dgA inhibited the protein synthesis of BL-38, NALM-6, REH and BL-2 cells by 50% at concentrations (IC50) of 4.0 x 10(-11) M, 6.0 x 10(-11) M, 8.0 x 10(-11) M and 3.0 x 10(-9) M, respectively. SWA11.dgA was subsequently used for the treatment of disseminated human BL-38 Burkitt's lymphoma in a newly developed SCID mouse model. The mean survival time (MST) of BL-38-bearing SCID mice was extended from 23 days in untreated controls to more than 230 days when 6 microg SWA11.dgA was applied intraperitoneally one day after tumor challenge. All of the animals achieved continuous complete remissions. SCID mice treated with SWA11.dgA 4 days after tumor cell challenge or a reduced dose of SWA11.dgA (67%) also had a significantly extended MST (45.0 and 51.4 days, respectively, as compared to 22.7 and 23.1 days in the controls). We conclude that SWA11.dgA might be of potential use for the treatment of lymphoma in man.
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Affiliation(s)
- R Schnell
- Department of Medicine I, University of Cologne, Germany
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Schoen G. Health screening at a regional dental meeting. N Y State Dent J 1969; 35:408-10. [PMID: 5256975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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