Weight Of Resected Specimen Research Articles

Randomized controlled trial comparing magnetic marker localization (MaMaLoc) with wire-guided localization in the treatment of early-stage breast cancer.

Wire-guided localization (WGL) is the standard of care in the surgical treatment of nonpalpable breast tumors. In this study, we compare the use of a new magnetic marker localization (MaMaLoc) technique to WGL in the treatment of early-stage breast cancer patients. Open-label, single-center, randomized controlled trial comparing MaMaLoc (intervention) to WGL (control) in women with early-stage breast cancer. Primary outcome was surgical usability measured using the System Usability Scale (SUS, 0-100score). Secondary outcomes were patient reported, clinical, and pathological outcomes such as retrieval rate, operative time, resected specimen weight, margin status, and reoperation rate. Thirty-two patients were analyzed in the MaMaLoc group and 35 in the WGL group. Patient and tumor characteristics were comparable between groups. No in situ complications occurred. Retrieval rate was 100% in both groups. Surgical usability was higher for MaMaLoc: 70.2±8.9 vs. 58.1±9.1, p<0.001. Patients reported higher overall satisfaction with MaMaLoc (median score 5/5) versus WGL (score 4/5), p<0.001. The use of magnetic marker localization (MaMaLoc) for early-stage breast cancer is effective and has higher surgical usability than standard WGL.

MP74-10 INTRAOPERATIVE MEASUREMENTS OF URETHRAL LENGTH AND BLADDER NECK DIAMETER AS PREDICTORS OF URINARY CONTINENCE AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy IV (MP74)1 Apr 2020MP74-10 INTRAOPERATIVE MEASUREMENTS OF URETHRAL LENGTH AND BLADDER NECK DIAMETER AS PREDICTORS OF URINARY CONTINENCE AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY Yasuo Kohjimoto*, Masatoshi Higuchi, Yuko Ueda, Takashi Iguchi, Hiroyuki Koike, Takahito Wakamiya, Shimpei Yamashita, Kazuro Kikkawa, and Isao Hara Yasuo Kohjimoto*Yasuo Kohjimoto* More articles by this author , Masatoshi HiguchiMasatoshi Higuchi More articles by this author , Yuko UedaYuko Ueda More articles by this author , Takashi IguchiTakashi Iguchi More articles by this author , Hiroyuki KoikeHiroyuki Koike More articles by this author , Takahito WakamiyaTakahito Wakamiya More articles by this author , Shimpei YamashitaShimpei Yamashita More articles by this author , Kazuro KikkawaKazuro Kikkawa More articles by this author , and Isao HaraIsao Hara More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000960.010AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To determine whether intraoperative measurements of urethral length (UL) and bladder neck diameter (BND) can predict patient-reported urinary continence status after robot-assisted radical prostatectomy (RARP). METHODS: Consecutive eligible patients undergoing RARP between June 2015 and March 2019 were enrolled into a prospective, longitudinal, observational cohort study. The primary outcomes were changes in urinary incontinence subscale of the Expanded Prostate Cancer Index Composite (EPIC) from baseline at 3, 6 and 12 months postoperatively. The primary exposures were UL and BND measured intraoperatively with a ruler. Other covariates included age, body mass index, NCCN risk category, nerve-sparing and weight of resected specimen. The relationship between EPIC score for urinary incontinence and intraoperative measurements (UL and BND) was evaluated using Wilcoxon-Mann-Whitney test and multivariate logistic regression analysis. RESULTS: A total of 365 patients were enrolled. The median change in EPIC score for urinary incontinence were -41.5, -21.8 and -12.5 at 3, 6, 12 months, respectively. The median UL and BND were 15mm and 17mm, respectively. Decrease in EPIC score for urinary incontinence at 12 months was smaller in patients with UL >15mm than those with UL ≤15mm (-6.3 vs -14.5, p=0.08), and so in patients with BND ≤17mm than those with BND >17mm (-6.3 vs -20.8, p=0.04). However, there were no differences between these groups at 3 and 6 months. Multivariate analyses revealed that patients with UL >15mm (OR 2.53, 95%CI 1.37-4.66, p<0.01) and those with BND ≤17mm (OR 2.70, 95%CI 1.45-5.03, p<0.01) had significantly higher odds of small decrease in EPIC score for urinary incontinence at 12 months (Table). CONCLUSIONS: The results demonstrated that longer UL and smaller BND were associated with significantly small decrease in EPIC score for urinary continence at 12 postoperatively, supporting the idea that preservation of membranous urethra and bladder neck during RARP improves continence recovery. Source of Funding: none © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1135-e1135 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yasuo Kohjimoto* More articles by this author Masatoshi Higuchi More articles by this author Yuko Ueda More articles by this author Takashi Iguchi More articles by this author Hiroyuki Koike More articles by this author Takahito Wakamiya More articles by this author Shimpei Yamashita More articles by this author Kazuro Kikkawa More articles by this author Isao Hara More articles by this author Expand All Advertisement PDF downloadLoading ...

Preoperative Evaluation of the Superficial Fascial System Can Predict Wound Complications in Body Contouring Surgery.

The demand for body contouring surgery continues to rise. The inclusion of the superficial fascial system (SFS) during closure of such procedures has been shown to improve outcomes; however, currently reported wound complication rates remain high. The authors assess whether decreased quantities of SFS are associated with wound complications in these patients. A retrospective study of patients undergoing body contouring surgery was performed. Preoperatively, ultrasound images were obtained of the SFS. Using Cellprofiler, the mean gray values (MGVs) of the SFS were calculated to quantify this structure. Chart review was performed to identify postoperative wound complications. Thirty-six patients were included: 30 abdominoplasties, 3 bilateral medial thigh lifts, and 3 bilateral brachioplasties. The overall wound complication rate was 22.5%. There were no significant differences in body mass index, age, smoking status, weight of resected specimen, or diabetes when comparing the complication and noncomplication groups. However, the MGV was significantly greater in the noncomplication group compared with the complication group (0.135 ± 0.008 vs 0.099 ± 0.005, respectively, P = 0.03). The average MGV for the entire cohort was 0.127. Patients with an MGV of greater than 0.127 had a wound complication rate of 0% compared with that of 39% for patients with an MGV of 0.127 or less (P = 0.005). Poor quantities of SFS identified by ultrasound were associated with increased wound complications in patients undergoing body contouring surgery. Furthermore, patients with better than average SFS seem to be protected from such complications.

Wireless Breast Localization Using Radio-frequency Identification Tags: The First Reported European Experience in Breast Cancer.

Wire-guided localisation (WGL) has been the mainstay for localisation of clinically occult breast lesions before excision. However, it has restrictive scheduling requirements, and causes patient discomfort. This has prompted the development of various wireless alternatives. In this prospective study we shall evaluate the role of radiation-free wireless localisation using a radiofrequency identification (RFID) tag and a hand-held reader (LOCalizer™) in the management of occult breast lesions. This technique was evaluated in a prospective cohort of 10 patients. The evaluation focused on: i) successful deployment, ii) identification and retrieval, iii) the status of surgical margins and need for re-operation, iv) resected specimen weight, v) marker migration rates (>5mm), and vi) acceptance by patients, radiologists and surgeons. RFID tags (n=11) were deployed under ultrasound guidance pre-operatively to localise occult breast lesions in 10 patients. The mean time for deployment of the RFID tag was 5.4 min (range=2-20). The mean distance from the lesion was 0.45 mm (range=0-3). The mean duration for retrieval was 10.2 min (range=6-20). Mean specimen weight was 19.6 g for malignant lesions (range=4.5-42). All tags were identified, and none had migrated. There were no positive margins, re-operations, nor complications. Patient feedback was highly positive. Both radiologists and surgeons rated the LOCalizer™ technique as better than WGL. Our study demonstrates that wireless localisation using RFID is an effective and time-efficient alternative to WGL, with low margin positivity and re-operation rates, and high patient, radiologist and surgeon acceptance.

Three-dimensional-printed custom-made hemipelvic endoprosthesis for primary malignancies involving acetabulum: the design solution and surgical techniques

BackgroundThis study is to describe the detailed design and surgical techniques of three-dimensional (3D)-printed custom-made endoprosthesis for hemipelvic tumorous bone defect.MethodsAccording to the pelvic tumor resection classification by Enneking and Dunham, the hemipelvis is divided into three zones including the ilium (P1), acetabulum (P2), and pubis and ischium (P3). Thirteen patients were included in this study. Of these, P1 and P2 were involved in three cases, while P1, P2, and P3 were involved in 10. Based on radiography data, 3D pelvic model was rebuilt, and virtual surgery was simulated. Different fixation methods were applied according to residual bone volume. Parameters of the first sacral (S1) vestibule, second sacral (S2) vestibule, the narrowest zone of superior pubic medullary cavity (NPSPMC), and the resected surface of superior pubic medullary cavity (RSSPMC) were selectively measured in various fixation methods. Model overlapping, feature simplifying, and size controlling were three basic steps during design procedure. Volume proportion of porous structure was determined according to estimated weight of resected specimen. Acetabular location, anteversion, and inclination were modulated. Screw diameter, direction, and combination were considered. The osteotomy guides and plastic models were used during surgery.ResultsOf 13 cases, after P1 resection, endoprostheses were fixed to sacra (8; 61.5%), ilia (3; 23.1%), and both (2; 15.4%). After P3 resection, endoprostheses were fixed to residual acetabulum (3; 23.1%), and residual pubis by stem (8; 61.5%) or “cap-like” structure (2; 15.4%). Mean area of the S1 vestibule, S2 vestibule, RSSPMC, and PSPMC were 327.9 (222.2 to 400), 131.7 (102.6 to 163.6), 200.5 (103.8 to 333.2), and 79.8 mm2 (40.4 to 126.2), respectively. Porous structure with 600 μm pore size and 70% porosity accounted for 68.8% (53.0 to 86.0) of the whole endoprosthesis on average. Mean acetabular anteversion and inclination were designed as 23.2° (20 to 25) and 42.4° (40 to 45). Median numbers of screws designed in the S1 vestibule was 5 (IQR, 4 to 6), in the S2 vestibule was 1 (IQR, 1 to 2), in the ilium was 5 (IQR, 2 to 6), and in the pubis was 1 (IQR, 1 to 1), while screws designed in the ischium was all 2. Median number of screws inserted in the S1 vestibule was 4 (IQR, 3 to 4), in the S2 vestibule was 1 (IQR, 1 to 1), in the ilium was 3 (IQR, 1 to 5), in the pubis was 1 (IQR, 0 to 1), and in the ischium was 1 (IQR, 1 to 1).ConclusionsThis study firstly presents detailed design and related surgical techniques of 3D-printed custom-made hemipelvic endoprosthesis reconstruction. Osseointegration is critical for long-term outcome and requires three design elements including interface connection, porous structure, and initial stability achieved by precise matching and proper fixation methods.

Clinical Outcome of Immediate Transurethral Surgery for Benign Prostate Obstruction Patients with Acute Urinary Retention: More Radical Resection Resulted in Better Voiding Function.

Introduction: Transurethral surgery of the prostate is currently the gold standard treatment modality for patients with benign prostatic hyperplasia (BPH) with recurrent acute urinary retention. This study aimed to evaluate the outcome and predictors of patients receiving immediate surgery after acute urinary retention (AUR) episodes. Materials and Methods: From January 2016 to January 2017, we retrospectively included 714 patients who received transurethral surgery of prostate due to BPH. Among them, 158 patients received surgeries immediately after an AUR episode. General characteristics data including age, Body mass index (BMI), International prostate symptom score (IPSS score), prostate volume and Prostate-specific antigen (PSA) were reviewed. We also collected surgery-related parameters including surgical types, operation time, and specimen weight. Resection ratio was defined as (resected specimen weight)/(Transurethral ultrasound (TRUS) volume). The catheterization status on discharge, post-operative medication for BPH, and AUR within 3 months after operation were evaluated. Statistical analysis was performed with Statistical product and service solutions (SPSS). Results: The mean age of the patients was 73.5 years, with a BMI of 24 kg/m2. IPSS total score was 25 with a Voiding symptom/Storage symptom score (V/S score) of 14.6 and 10.4, respectively. A total of 74 (46.8%) patients still took medication for BPH for over 1 month after the surgeries, 28 (17.7%) patients were not catheter-free at the time of discharge, and 14 (8.9%) patients had AUR within 3 months after the surgeries. Surgical type did not impact the outcome of surgeries. In patients who received Transurethral resection of the prostate (TURP), the resection ratio is the only predictor for the catheterization status on discharge and post-operative medication for BPH within 3 months after operation. Conclusions: In patients with BPH-related AUR followed by immediate transurethral surgeries, more radical resection is significantly correlated with short-term medication-free and catheter-free status.

Patient satisfaction after unilateral oncoplastic volume displacement surgery for breast cancer, evaluated with the BREAST-Q\u2122

BackgroundOncoplastic breast-conserving surgery allows larger resections in unfavorable locations, with an improved chance of preserving esthetics. Indications and timing for potential contralateral surgery to obtain symmetry are not clear. The aim of this study was to evaluate patient satisfaction after unilateral oncoplastic volume displacement surgery, to investigate potential risk factors for lower patient satisfaction and to assess patient wish for contralateral surgery.MethodA cohort of 144 women, consecutively treated for breast cancer with unilateral breast-conserving oncoplastic volume displacement surgery, followed by radiotherapy and with an unoperated contralateral breast, was sent the BREAST-Q™ breast-conserving therapy (BCT) and a study-specific questionnaire. In all, 120 women (83%) responded. For these women, the median value for resected specimen weight was 92 g (range 14–345) and for the estimated percentage of the breast volume excised 15% (range 3–35%).ResultsThe median patient-reported score for “Satisfaction with breast” (BREAST-Q™ BCT) was 74/100. Factors associated with a score below median value in a simple logistic regression model adjusted for age and BMI were axillary clearance (OR 2.46, 95% CI 1.09–5.56), neoadjuvant chemotherapy (OR 3.26, 95% CI 1.15–9.24), and low breast density (OR 2.32 95% CI 1.02–5.29). Thirteen women (11%) were interested in contralateral surgery.ConclusionMost patients in this study cohort, who had undergone breast-conserving therapy with oncoplastic volume displacement techniques, were satisfied with their breasts without surgery to the contralateral breast. This indicates that contralateral surgery to achieve symmetry only should be performed after individual evaluation and as a delayed procedure.

Laparoscopic Multiple Parenchyma-sparing Concomitant Liver Resections for Colorectal Liver Metastases.

Parenchyma-sparing concept in liver surgery has received a new incitement with the introduction of laparoscopic techniques. Multiple concomitant liver resections are a major component in the parenchyma-sparing concept. In total, 689 patients underwent laparoscopic liver resection for colorectal liver metastases from August 1998 to 2017, and 171 patients were eligible for this study. Patients were divided into 3 groups: group I with single liver resection (36 patients); group II with multiple concomitant liver resections (104 patients); group III with liver resection(s) combined with concomitant liver ablation (31 patients). Perioperative outcomes and survival were compared between the groups I and II, whereas variables of group III were presented as complementary information, avoiding statistically exigent multiple comparisons. There were 6 conversions, 0, 3 (2.9%), and 2 (6.5%), respectively in the groups I, II, and III. Median operative time was 161, 186, and 224 minute in the groups I, II, and III, respectively. Median blood loss was 300 mL in groups I and II, and 200 mL in group III. It was a tendency to higher rate of postoperative complications in the group of single resections with morbidity rate of 31%, 19%, and 23% in group I, II, and III, respectively. Median postoperative stay was 3 days in all groups. Tumor-free margin resection was achieved in 92%, 86%, and 93%, respectively in the groups I, II, III. The median weight of resected specimen was significantly lower in group II (90 vs. 257 g; P<0.001). There were no significant differences in survival between the groups. The 5-year overall survival was 31%, 42%, and 43% for groups I, II, and III, respectively. Laparoscopic multiple concomitant parenchyma-sparing liver resections provide surgical and oncologic outcomes comparable with single greater resections for multiple lesions. This approach could be recommended for a wide application in specialized hepatopancreatobiliary centers.

Efficacy of bipolar transurethral resection of the prostate using TURIS: our short term experience

Background: Objective of the study was to report our short term experience regarding efficacy of bipolar transurethral resection of prostate using TURIS (transurethral resection in saline) system.Methods: Between May 2016 to April 2017 49 consecutive patients underwent bipolar transurethral resection of prostate (B-TURP) at our institute. All patients were evaluated preoperatively by physical examination, ultrasonography and laboratory studies, including measurement of hemoglobin, serum sodium, and prostate specific antigen levels. Patients were assessed postoperatively at three, six and 18 months.Results: The mean age of the patients was 64.83±7.47 years and mean preoperative prostate volume was 64.73±13.59 ml. The mean preoperative hemoglobin was 13.32±0.9 g/l and mean postoperative hemoglobin was 12.09±1.11 g/l. The mean resection time was 57.02±14.37 minutes and mean resected specimen weight was 41.69±12.15 gm. The mean preoperative maximum urinary flow rate (Qmax) was 8.6±1.17 ml/s and mean Qmax at three, six and 18 months follow up was 18.85±2.15, 19.43±1.49 and 18.98±1.6 ml/s respectively. The mean preoperative international prostate symptom score (IPSS) was 26.32±2.69 and mean IPSS at three, six and 18 months follow up was 6.68±1.36, 6.47±0.79 and 6.30±0.9 respectively. Only one patient developed urethral stricture during follow up.Conclusions: The B-TURP is efficacious and results in significant improvement in IPSS and Qmax. The urethral stricture rate after B-TURP is not different from monopolar TURP.

Liver Three-Dimensional Reconstruction Accurately Predicts Remnant Liver Volume for HBV-Related Hepatocellular Carcinoma Prior to Hepatectomy

Accurate prediction of future remnant liver volume preoperatively is vital to avoid posthepatectomy liver failure (PHLF). In this study, we evaluated the accuracy and efficiency of Myrian software for predicting resected liver volume and future remnant liver volume for hepatitis B virus (HBV)-related hepatocellular carcinoma prior to liver resection. Patients with HBV-related hepatocellular carcinoma undergoing liver three-dimensional CT reconstruction prior to or after hepatectomy were enrolled in this study. All three-dimensional reconstructions were completed by two observers (observers 1 and 2) separately. Resected specimen weights were obtained in the operating room after liver resection. The correlations between resected liver volume and resected specimen weights, planned remnant liver volume (RLV) and actual RLV were analyzed. Bland-Altman plots were used to assess interobserver variability between observers 1 and 2. A total of 42 patients were enrolled in the study, including 32 men and 10 women with a median age of 49 years. The mean time needed to perform complete volumetry in a patient was 20.8 ± 2.9 min and 23.7 ± 3.8 min for observers 1 and 2, respectively. The resected liver volume of observers 1 and 2 measured by Myrian software correlated strongly with the resected specimen weight (P < 0.0001, r = 0.980; P < 0.0001, r = 0.982, respectively). Pearson’s correlation analysis showed that the planned RLV had a strong positive correlation with the actual RLV for observers 1 and 2 (P < 0.0001, r = 0.957; P < 0.0001, r = 0.949, respectively). Low interobserver variability was observed between observers 1 and 2. Liver three-dimensional CT reconstruction can accurately predict resected liver volume and future remnant liver volume for HBV-related hepatocellular carcinoma prior to liver resection.

Revisiting Types and Risk Factors for Thyroid Malignancy in a State Endemic of Iodine Deficiency Goiter

ABSTRACT Introduction We have realized that recent rise in incidence of thyroid malignancy is partly because of incidental findings of cancer after resection for benign goiters. Therefore, we aim to reanalyze risk factors for thyroid malignancy in those patients who underwent primary thyroid surgery at Breast and Endocrine Surgical Unit, Department of Surgery, Hospital Raja Perempuan Zainab II, Kota Bharu, Kelantan, Malaysia. Materials and methods Retrospective review in our database found 699 patients who had undergone thyroid surgeries between June 2007 and December 2014. According to the final histopathological report of resected specimen, these patients, operated for goiter, were divided into two groups: Thyroid malignancy group and nonmalignancy group. Logistic regression analysis was used to estimate the risk of age, duration and weight of resected specimen for having thyroid malignancy. Results The mean value for age was 43.5 years [standard deviation (SD) = 14.0); duration of neck swelling was 5.9 months (SD = 6.7); and weight of resected specimen was 157 gm (SD = 161.0). Around 26.9% cases had thyroid malignancy (n = 188), about 77.13% cases had papillary thyroid carcinoma and 17.6% had follicular thyroid carcinoma. Age associates with risk for malignancy (p &lt; 0.001), but duration of neck swelling (p = 0.513) and weight of resected specimen (p = 0.955) do not relate with this. With an increase of 1 year of age, the odds to have thyroid malignancy increase for 2%. This is equivalent with 14.4% increase in cancer for every 5-year increase in age. Conclusion Our study has found that increasing age is the only associated factor for risk of thyroid malignancy. When managing elderly patients who has clinically benign goiter, differential diagnosis of thyroid cancer need be considered as well. How to cite this article Wong MW, Hadi IA, Musa KI. Revisiting Types and Risk Factors for Thyroid Malignancy in a State Endemic of Iodine Deficiency Goiter. World J Endoc Surg 2017;9(2):51-54.

Measuring change in prostate size after holmium laser enucleation: A prospective study.

PurposeTo analyze postoperative outcomes of prostate surgery, resected specimen weight is commonly used. The difference between the preoperative calculated transitional zone volume and actual enucleated specimen weight following holmium laser enucleation of the prostate (HoLEP) is reported at over 20%. The reason for this difference is unclear. We assessed the association of volume of the prostatic adenoma with enucleated weight, the volume and calculated volume of the adenoma by pre- and postoperative ultrasonographic measurement.Materials and MethodsAll patients were prospectively enrolled who underwent HoLEP by two surgeons (SJO and JKO) between 2010 and 2015. Preoperative and postoperative prostate ultrasonography examinations were performed by a single examiner (JKO) during surgery, and weight and volume of the enucleated adenoma were measured. We compared preoperative adenoma size with postoperative weight and volume of the enucleated adenoma, calculated enucleated volume using ultrasonography, and calculated the correlation coefficients between preoperative adenoma volume and postoperative parameters.ResultsOne hundred forty-two patients with a mean age (±standard deviation) of 69.8 (±8.8) years were analyzed. The mean preoperative ultrasound-measured adenoma volume was 31.7 (±21.4) mL, while postoperatively the mean retrieved weight of the adenoma was 22.3 (±17.0) g and the mean volume was 22.3 (±16.8) mL. Postoperatively calculated enucleated volume using ultrasonography was most strongly correlated with preoperative adenoma size (Pearson correlation coefficient 0.965, p<0.01).ConclusionsOur study showed a significant difference between preoperative adenoma size and postoperative enucleated weight of adenoma during HoLEP. Postoperatively calculated enucleated volume using ultrasonography may be the most reliable parameter to assess surgical outcomes following HoLEP.

Learning transurethral resection of the prostate: A comparison of the weight of resected specimen to the weight of enucleated specimen in open prostatectomy.

Minimally invasive procedures in the surgical management of benign prostate enlargement (BPE) are of limited use in the resource-poor settings due to nonavailability of the requisite facilities and skills. It has been observed that teaching uroendoscopy inclusive of transurethral resection of the prostate (TURP) can be challenging in the resource-poor settings where the traditional master-apprentice (Halstedian) approach has remained the prevalent training technique. We aimed in this retrospective study to assess completeness of resection in TURP by comparing the proportion of prostate tissue resected to the proportion enucleated in open retropubic prostatectomy (ORP). We included all BPE patients on urethral catheter managed in the first 18 months after Halstedian training in TURP. The analysis was done using SPSS® 20 and VassarStats® online software. Twenty patients' files for TURP and twenty-eight patients' files for ORP met the inclusion criteria. Patients in the 2 treatment arms were similar in age (P = 0.22), body mass index (P = 0.45), proportion of prostate tissue extirpated (P = 0.38), and International Prostate Symptom Score 12-month postprocedure (P = 0.06). However, larger prostates were treated with ORP (P < 0.0005). The correlation of the weight of resected specimen to preoperative prostate volume (PV) (r = 0.78; P < 0.001) was similar to that of enucleated specimen to preoperative PV (r = 0.89; P < 0.001). Similarly, the proportion of extirpated specimen correlated positively with the preoperative PVs for both TURP (r = 0.23; P = 0.33) and ORP (r = 0.292; P = 0.13), with no evidence of any difference between the 2 correlation values (P = 0.84). With appropriate patient selection, especially as a newly trained Surgeon, resections in TURP are as complete as enucleations in ORP.

Predictive Factors for Drainage Volume after Expander-based Breast Reconstruction.

Background:Closed suction drains are widely used in breast reconstruction, and the drains are removed based on a volume criterion. However, to the best of our knowledge, there has been no study analyzing predictive factors for drainage volume after breast reconstruction.Methods:Data of daily drainage in cases with expander-based breast reconstruction between February 2013 and March 2015 (131 patients and 134 expanders) were retrospectively analyzed. Patient factors and operative factors were examined for their influences on total drainage using univariate and multivariate analyses.Results:The total drainage was 557.3 ± 359.7 mL. A strong correlation was observed between total drainage and duration of drains (correlation coefficient, 0.908). Operative factors, such as mastectomy type, expander type, operative time, and blood loss, did not affect the total drainage. Patients with axillary lymph node dissection showed a higher total volume of drainage (P < 0.001). The weight of the resected specimen, body weight, and breast volume calculated preoperatively showed a strong correlation with total drainage (correlation coefficients, 0.454, 0.388, and 0.345, respectively). In multiple regression analysis with preoperative data, age (P = 0.008), body weight (P = 0.018), and scheduled axillary dissection (P < 0.001) were significant predictive factors for total drainage. Among postoperative data, age (P = 0.003), axillary dissection (P = 0.032), and weight of resected specimen (P = 0.013) were significant predictors.Conclusions:Based on preoperative and/or postoperative information, plastic surgeons can predict the total drainage and duration of drains after expander-based breast reconstruction. Age, breast mass, and axillary lymph node dissection are important factors for this prediction.

Incidentally Detected Adenocarcinoma Prostate in Transurethral Resection of Prostate Specimens: a Hospital Based Study from India.

Awareness about prostate cancer has increased in the community, and prostate cancer screening examinations, including prostate specific antigen (PSA) assays, are now widely available. Prior to the PSA era, up to 27% of prostate cancers were detected incidentally at the time of transurethral resection of prostate (TURP). After PSA testing became widely available, the incidence of incidentally detected carcinoma prostate in TURP specimens without prior diagnosis reduced to 5-13%. However, the incidence of incidentally detected carcinoma prostate has been reported to vary across the globe since various factors can influence the identification of this malignancy in TURP specimens. In this paper, we focus on rates of incidentally detected prostate cancer in TURP specimens in our hospital and correlate it with various parameters. This retrospective study of histopathological findings of biopsy specimens was conducted for patients undergoing TURP during a period of 5 years from April 2010. The inclusion criteria were patients diagnosed with benign prostatic hyperplasia (BPH) (digital rectal examination (DRE) not showing any abnormally hard areas and normal age adjusted PSA values). Patients with elevated PSA, abnormal DRE, documented urinary tract infection and proved adenocarcinoma prostate (CaP) were excluded from the study. The total weight of prostatectomy specimen, occurrence of carcinoma prostate in the chips, percentage of total tissue resected showing malignancy and Gleason's scores were recorded. A total of 597 patients belonging to the inclusion criteria were studied. The incidence of occult CaP in the study group was 5.2 % (31/597). Out of these, 8 belonged to T1a and 23 belonged to T1b stages. The age group 70 - 79 years had the maximum incidence of occult CaP. It was observed that the clinical grading of prostate did not have a bearing on the incidence of occult CaP whereas the weight of resected specimen correlated with the incidence of CaP. The incidence of occult CaP was greater with low volume prostates (<20 g). (P=0.15). The rate of incidentally detected adenocarcinoma prostate in patients undergoing TURP for clinically diagnosed BPH was found to be only 5.2 % in our study which is low when compared with similar studies done elsewhere. The age of the patient and weight of the resected specimen correlated with incidence of occult prostate cancer. The clinical grading of prostate by DRE however, demonstrated no correlation.

Clinical score to predict the risk of bile leakage after liver resection.

BackgroundIn liver resection, bile leakage remains the most common cause of operative morbidity. In order to predict the risk of this complication on the basis of various factors, we developed a clinical score system to predict the potential risk of bile leakage after liver resection.MethodsWe analyzed the postoperative course in 518 patients who underwent liver resection for malignancy to identify independent predictors of bile leakage, which was defined as “a drain fluid bilirubin concentration at least three times the serum bilirubin concentration on or after postoperative day 3,” as proposed by the International Study Group of Liver Surgery. To confirm the robustness of the risk score system for bile leakage, we analyzed the independent series of 289 patients undergoing liver resection for malignancy.ResultsAmong 81 (15.6 %) patients with bile leakage, 76 had grade A bile leakage, and five had grade C leakage and underwent reoperation. The median postoperative hospital stay was significantly longer in patients with bile leakage (median, 14 days; range, 8 to 34) than in those without bile leakage (11 days; 5 to 62; P = 0.001). There was no hepatic insufficiency or in-hospital death. The risk score model was based on the four independent predictors of postoperative bile leakage: non-anatomical resection (odds ratio, 3.16; 95 % confidence interval [CI], 1.72 to 6.07; P < 0.001), indocyanine green clearance rate (2.43; 1.32 to 7.76; P = 0.004), albumin level (2.29; 1.23 to 4.22; P = 0.01), and weight of resected specimen (1.97; 1.11 to 3.51; P = 0.02). When this risk score system was used to assign patients to low-, middle-, and high-risk groups, the frequency of bile leakage in the high-risk group was 2.64 (95 % CI, 1.12 to 6.41; P = 0.04) than that in the low-risk group. Among the independent series for validation, 4 (5.7 %), 16 (10.0 %), and 10 (16.6 %) patients in low-, middle, and high-risk groups were given a diagnosis of bile leakage after operation, respectively (P = 0.144).ConclusionsOur risk score model can be used to predict the risk of bile leakage after liver resection.

Impact of parenchymal loss on renal function after laparoscopic partial nephrectomy under warm ischemia.

To elucidate the impact of renal parenchymal loss and the ischemic reperfusion injury (RI) on the renal function after laparoscopic partial nephrectomy (LPN) under warm ischemia (WI). Thirty-five patients with a single polar renal mass ≤4cm and normal contralateral kidney underwent LPN. Transperitoneal LPN with WI using en bloc hilar occlusion was performed. The total differential renal function (T-DRF) using 99mTc-dimercaptosuccinic acid was evaluated preoperatively and postoperatively over a period of 1year. A special region of interest (ROI) was selected on the non-tumorous pole of the involved kidney, and was compared with the same ROI in the contralateral kidney. The latter comparison was defined as partial differential renal function (P-DRF). Any postoperative decline in the P-DRF of the operated kidney was attributed to the RI. Subtraction of the P-DRF decline from the T-DRF decline was attributed to the parenchymal loss caused by the resection of the tumor and suturing of the normal parenchyma. The mean WI time was 22min, and the mean weight of resected specimen was 18g. The mean postoperative eGFR declined to 87ml/min/1.73m2 from its baseline mean value of 97ml/min/1.73m2 (p value=0.075). Mean postoperative T-DRF and P-DRF of the operated kidney declined by 7 and 3%, respectively. After LPN of small renal mass, decline in renal function is primarily attributed to parenchymal loss caused by tumor resection and suturing of the normal parenchyma rather than the RI.

Early postoperative outcome of bipolar transurethral enucleation and resection of the prostate.

To report the early postoperative outcome of bipolar transurethral enucleation and resection of the prostate. Our results were compared with those published from various centres. Regional hospital, Hong Kong. A total of 28 consecutive patients who had undergone bipolar transurethral enucleation and resection of the prostate by a single surgeon between January and June 2014. All patients were evaluated preoperatively by physical examination, digital rectal examination, transrectal ultrasonography, and laboratory studies, including measurement of haemoglobin, sodium, and prostate-specific antigen levels. Patients were assessed perioperatively and at 4 weeks and 3 months postoperatively. The mean resected specimen weight of prostatic adenoma in 28 patients was 48.2 g with a mean enucleation and resection time of 13.6 and 47.7 minutes, respectively. There was a mean decrease in serum prostate-specific antigen by 85.9% (from 6.4 ng/mL to 0.9 ng/mL) postoperatively. Prostate volume was decreased by 68.2% (from 71.9 cm(3) to 22.9 cm(3)) at 4 weeks postoperatively. The mean postoperative haemoglobin drop was 11.5 g/L. The rate of transient urinary incontinence at 3 months was 3.6%. Patients who underwent bipolar transurethral enucleation and resection of the prostate had a short catheterisation time and hospital stay, which is comparable to conventional transurethral resection of the prostate. Bipolar transurethral enucleation and resection of the prostate should become the endourological equivalent to open adenomectomy with fewer complications and short convalescence. The technique of bipolar transurethral enucleation and resection of the prostate can be acquired safely with a relatively short learning curve.

Long-term objective esthetic outcome after breast-conserving therapy.

The prediction of unfavorable long-term esthetic outcome (AO) is important for patient consultation. We aimed to analyze variables characterizing the improvement and impairment of AO over time after breast-conserving surgery. A subgroup of a prospective, monocenter cohort study was analyzed to evaluate the results of the BCCT.core software (Breast Cancer Conservative Treatment.cosmetic results) which was used to objectively assess the AO before (n = 356), shortly after (n = 294) and in median 3 years after surgery (n = 356). We analyzed potential influencing factors (such as body mass index, (y)pT-stage, weight of resected specimen, etc.) on the AO using logistic regression analyses (n = 256). Finally, we tried to characterize groups of patients with improving or impaired AO over time (n = 294). Predictors for an unfavorable AO were an axillary lymphadenectomy (OR = 4.05), a tumor in the 12 o'clock position (OR = 2.22), a tumor stage larger or equal to (y)pT2 stage (OR = 2.11), and a surgical specimen weight >75 g (OR = 2.71). Patients with lower specimen weight were more likely to improve in the long-term follow-up (p = 0.018), whereas patients with a higher (y)pT-stage tended to become impaired with time. Although overall AO decreased over time, nearly half of the patients with an unfavorable AO shortly after surgery improved in the long-term follow-up. Predictors of unfavorable AO can be used in patient consultation preoperatively to prepare them for the postsurgical period and/or to recommend surgical alternatives (e.g., more complex oncoplastic techniques). Knowledge of improvement and impairment may help patients and physicians in the postsurgical consultation setting.

Reappraisal of the Inferior Right Hepatic Vein Preserving Liver Resection

Background: To resect tumors infiltrating to the right hepatic vein at its root, right hemihepatectomy or that following portal vein embolization (PVE) is applied. If the IRHV is sizable, the IRHV preserving liver resection can be another option. Methods: Between 1994 and 2007, the IRHV preserving liver resection was performed in 21 patients (IRHV group). The short-term outcomes after surgery of them p. Results: There were no mortality and no significant difference between the IRHV and RH groups concerning the blood loss, the morbidity rates and the duration of hospital stay. The median operation time was shorter in the IRHV group than in the RH group (393 vs. 480 min, p = 0.0409). The median weight of resected specimen of the IRHV group was 293 g (range: 20-982), which was significantly lighter than that of the RH group (median: 680 g [250-4,300], p < 0.001). The median percentage of resected volume to standard liver volume was significantly smaller in the IRHV group than in the RH group (25.8 vs. 52.2%, p < 0.001). Conclusion: The IRHV preserving liver resection remains a safe and useful procedure.