Transperitoneal laparoscopic partial nephrectomy using a new technique

We report our experience with a new technique for transperitoneal laparoscopic partial nephrectomy with the kidney turned upside down intraoperatively. Laparoscopic partial nephrectomy was performed in 10 patients with upper pole lesions through a transperitoneal approach. Once complete mobilization of the kidney was achieved, it was rotated 180 degrees around the horizontal axis, so that the upper pole was positioned inferiorly. After performing partial nephrectomy, the resection bed was sutured by 2-0 polyglactin sutures and application of Hem-o-Lok clips. Then, the kidney was returned into its normal position and fixed to the abdominal wall. We performed laparoscopic partial nephrectomy on 9 patients with a contrast-enhancing upper pole kidney mass and 1 patient with a nonfunctioning upper pole. The median tumor size was 58 mm [range, 41 mm to 92 mm]. The median operative time was 206 minutes [range, 114 to 262 minutes] and the mean warm ischemia time was 30 minutes [range, 22 to 35 minutes]. One patient underwent surgical exploration due to bleeding 6 hours after the operation. Prolonged urine leakage [more than 7 days] was observed in 1 patient, which responded to ureteral stent insertion. Surgical margins were negative in all of the patients. Renal cell carcinoma was histologically diagnosed in patients with a kidney tumor. Laparoscopic upper pole partial nephrectomy had acceptable results while the kidney was turned upside down intraoperatively, in terms of operative time and complications. This approach facilitates the procedure by achieving a better field of vision

Diagnosis of bladder cancer by urine survivin, an inhibitor of apoptosis a preliminary report

Survivin is an inhibitor of apoptosis that is expressed in undifferentiated tissues like tumors. Detection of survivin in urine has been proposed as a diagnostic marker for bladder cancer. We evaluated the urine samples of patients with bladder cancer for survivin and compared them with healthy controls. The urine specimens of 20 patients with transitional cell carcinoma [TCC] of the bladder [group 1] and 18 controls without cancer [group 2] were collected before cystoscopy and assessed for survivin by reverse transcriptase polymerase chain reaction. All patients except 1 in group 1 were men. Urine specimens were positive for survivin in 18 [90%] and 9 [50%] patients of groups 1 and 2, respectively [P = .007]. Sixteen patients with TCC had urine cytology, of which 6 [37.5%] were positive. Urine survivin was positive in all 10 patients with negative cytology. Nine patients in this group had low-grade tumors. Urine survivin seems to have a higher sensitivity than urine cytology, especially in low-grade bladder cancer. The quantitative measurement of survivin in urine by advanced techniques may provide a better diagnostic and prognostic tool. However, the clinical use of survivin and its association with different stages and grades of TCC still requires more studies

Evaluating expression and potential diagnostic and prognostic values of survivin in bladder tumors: a preliminary report

Survivin, an inhibitor of apoptosis [IAP], has been reported to be capable of regulating both cellular proliferation and apoptotic cell death. Survivin expression has been described during embryonic development and in adult cancerous tissues, with greatly reduced expression in adult normal differentiated tissues, particularly if their proliferation index is low. In the present study, the expression and potential diagnostic and prognostic value of survivin in bladder tumors was evaluated. Primary and recurrent bladder tumor specimens were obtained from patients referred to the Shaheed Labbafinejad Medical Center in Tehran, Iran. Total RNA was isolated from frozen tissues, reverse transcribed and amplified by means of a nested polymerase chain reaction technique. Survivin was detected in 3 cases of primary tumors [42.8%] and 6 cases of recurrent tumors of bladder [60%]. Survivin-deltaEx3 expression was seen in 41.2% of the 17 cases with bladder cancer. Our findings suggest that the expression of survivin and survivin-deltaEx3 is well associated with invasive and more-aggressive forms of bladder cancer. Our data also indicate that the presence of survivin-deltaEx3 is better correlated with tumorigenesis of bladder cancer compared with survivin expression