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상부 요상피암에 대한 변형된 앙와위 손을 이용한 복강경 신요관적출술
백성현(Sung Hyun Paick),박형근(Hyoung Keun Park),노용수(Yong Soo Lho),추관엽(Gwoan Youb Choo),김형곤(Hyeong Gon Kim) 대한비뇨기종양학회 2011 대한비뇨기종양학회지 Vol.9 No.3
Purpose: We developed modified supine position hand-assisted laparoscopic nephroureterectomy (MS-HALNU) without position change during the operation in patients with upper urinary tract urothelial cell carcinoma. So, we report these results. Materials and Methods: Twenty two patients (including three with metastatic cancer) with upper urinary tract urothelial cell carcinoma underwent a unilateral MS-HALNU. Patient’s position was supine but operation side was elevated 30 degree with soft pad. An 8cm Gibson incision on the operation side was performed for a distal ureterectomy and bladder cuff excision, which were carried out as open surgery. The nephroureterectomy was followed without position change using hand-assisted technique via the same incision and two additional 10mm ports. Results: All 22 MS-HALNUs were successfully completed without open conversion; there were no major complications. The average operation time was 257 minutes and the average estimated blood loss was 173ml. The average interval to resuming oral intake was 2.6 days and the average hospital stay was 8.6 days. The average follow-up period was 30.1 months. In 15 localized cases (below T2), no recurrence occurred. However, in four T3 cases, 3 recurrences (2 bladder) occurred even with adjuvant chemotherapy. In 3 palliative cases, all patients died due to disease progression. Conclusions: MS-HALNU is easy, safe and effective treatment for patients with upper urinary tract urothelial cell carcinoma.
손가락 끝 박리법을 이용한 손을 이용한 복강경 부분신절제술의 초기 경험
이영익(Young Ik Lee),김대현(Dae Hyun Kim),김지원(Ji Won Kim),함동엽(Dong Yeub Ham),배상락(Sang Rak Bae),박형근(Hyoung Keun Park),김형곤(Hyeong Gon Kim),노용수(Yong Soo Lho),백성현(Sung Hyun Paick) 대한비뇨기종양학회 2013 대한비뇨기종양학회지 Vol.11 No.2
Purpose: We reported the initial experience of hand-assisted laparoscopic partial nephrectomy (HALPN) for kidney neoplasm using finger-tip dissection technique. Materials and Methods: A total 11 patients with exophytic renal mass who had undergone HALPN for kidney neoplasms. After mobilizing the entire hilum thoroughly, the renal artery was hung with a rubber catheter. When massive bleeding occurred, it was clamped. Surgeon’s index finger-tip was used for the mass dissection. After making the incision line 5-10mm from the mass using scissors, the resection plane was gradually deepened bluntly by the finger-tip, which was directed centrally along the grain of the renal pyramids. If large vessels and calyxes were felt by the finger-tip during dissection, they were secured by clipping. The mass was completely removed by pinching off using the fingers. Results: Mean patient age was 51.4 years (37-72 years), mean tumor size was 2.1cm (1.0-3.0cm), the mean operation time was 163.4min (120-310min). In only five patients, renal artery was clamped. In these cases, mean ischemic time was 24min (15-30min). All patients had negative resection margins. Mean estimated blood loss was 304.8ml (63-900ml) and two patients required a post-operative blood transfusion. No serious complications occurred. Conclusions: The finger-tip dissection technique of renal mass in HALPN is feasible. This technique can allow the easy and safe dissection by the maximizing the tactile sense.
근치적 전립선절제술 후 요실금 발생 환자에서의 항콜린제 처방에 대한 비뇨기과 의사의 실태조사
방우진(Woo Jin Bang),주관중(Kwan Joong Joo),조진선(Jin Seon Cho),전성수(Seong Soo Jeon),백성현(Sung Hyun Paick),성도환(Do Hwan Seong),김홍섭(Hong Sup Kim),함원식(Won Sik Ham),홍성준(Sung Joon Hong) 대한비뇨기종양학회 2012 대한비뇨기종양학회지 Vol.10 No.2
Purpose: We surveyed the actual use of anticholinergics for urinary incontinence after radical prostatectomy among the practicing urologists. Materials and Methods: 142 urologist members of the Korean Urological Oncology Society were given surveys through conventional mail and e-mail with 76 members returning responses. Answering for the number of radical prostatectomy performed each year, 21 urologists responded more than 50 cases, 37 responded 10 to 50 cases, 11 responded 5 to 10 cases, and 7 said 1 to 5 cases. Concerning primary approach, retropubic approach surgery, laparoscopic surgery, robotic surgery and perineal approach surgery each had 39, 19, 17, and 1, respectively. Results: Among 76 participants, 64 (84%) acknowledged prescribing anticholinergics after prostatectomy depending on symptoms. For post-op indication of anticholinergics, 43 members responded significant incontinence symptoms, while 19 answered frequent urination. Concerning the initiation of medication, 52 answered when symptoms arise after catheter removal. For duration of anticholinergics, less than 30 days, 31-60 days, 61-90 days, more than 90 days each received 8, 17, 24, and 15 votes from participants, respectively. Finally, 57 members thought the use of anticholinergics were beneficial in treating urinary incontinence after radical prostatectomy. Conclusions: Over 80% of survey participants acknowledged prescribing anticholinergics to urinary incontinence patients according to symptoms, and 75% concurred with their usefulness. But, there is no specified protocol of anticholinergics use for urinary incontinence after radical prostatectomy.