Comparison of robotic and laparoscopic lateral transperitoneal adrenalectomies

Purpose@#This study aimed to compare the intraoperative and postoperative outcomes between robotic and laparoscopic transperitoneal adrenalectomies. @*Methods@#In this retrospective study, 93 patients underwent adrenalectomy using 2 surgical modalities: 45 patients underwent adrenalectomy using the da Vinci Xi system (robotic group), and 48 patients using laparoscopic devices (laparoscopic group). We compared the operation time, intraoperative bleeding, and hospital stay according to the surgical modality and tumor characteristics. @*Results@#There were no significant differences in the operative time (P = 0.827), hospital stay (P = 0.177), and intraoperative bleeding (P = 0.174) between the groups. However, the robotic group showed a lower coefficient of variation in total operative time than that of the laparoscopic group (100.6 ± 23.3 minutes vs. 101.9±32.7 minutes, 0.230 vs. 0.321). When divided into 2 subgroups based on the tumor size (3 cm had a shorter operative time than that of the laparoscopic group (P = 0.032). The robotic group also had fewer cases of intraoperative bleeding (P = 0.034). @*Conclusions@#Compared to the laparoscopic transperitoneal adrenalectomy, the robotic one achieved a lower deviation in total operative time and showed less bleeding and a shorter operative time, especially for tumors sized >3 cm.

The Impact of the Amendment of the Health Insurance Coverage for F-18 Fluorodeoxyglucose Positron Emission Tomography on the Healthcare Behaviors for Breast Cancer:An Interrupted Time Series Analysis of the Korean National Data From 2013 to 2018

Background@#F-18 Fluorodeoxyglucose positron emission tomography (F-18 FDG PET), which can cover the body from the skull base to the thigh in one scan, is beneficial for evaluating distant metastasis. F-18 FDG PET has interested policymakers because of its relatively high cost. This study investigated the effect of the F-18 FDG PET reimbursement criteria amendment on healthcare behavior in breast cancer using an interrupted time series (ITS) analysis. @*Methods@#We retrospectively analyzed the inpatient and outpatient data from Korea’s Health Insurance Review and Assessment Service (HIRA) from January 1, 2013 to December 31, 2018. ITS analysis was performed for the number of each medical imaging modality and the total medical imaging cost of the breast cancer patients. @*Results@#The annual number of breast cancer patients has been increasing steadily since 2013. The trend of F-18 FDG PET increased before the reimbursement criteria was amended, but intensely decreased immediately thereafter. The chest and abdomen computed tomography scans showed a statistically significant increase immediately after the amendment and kept steadily increasing. A change in the total medical imaging cost for the breast cancer patient claimed every month showed an increasing trend before the amendment (β = 5,475, standard error [SE] = 1,992, P = 0.008) and rapid change immediately after (β = −103,317, SE = 16,152, P < 0.001). However, there was no significant change in the total medical imaging cost at the long-term follow-up (β = −912, SE = 1,981, P = 0.647). @*Conclusion@#Restriction of health insurance coverage for cancer may affect healthcare behaviors. To compensate for it, the policymakers must consider this and anticipate the impact following implementation.

Comparison of Single Incision Endoscopic Nipple-Sparing Mastectomy and Conventional NippleSparing Mastectomy for Breast Cancer Based on Initial Experience / 한국유방암학회지

Purpose@#Endoscopic breast surgery for patients with breast cancer was introduced for its superior cosmetic outcomes; it was initially studied in the field of breast-conserving surgery and, more recently, in robotic-assisted nipple-sparing mastectomy (NSM). The main purpose of this study was to investigate the feasibility and safety of endoscopic NSM (E-NSM) in patients with breast cancer by comparing E-NSM and conventional NSM (C-NSM). @*Methods@#Between May 2017 and October 2020, we retrieved the records of 45 patients who underwent NSM with permanent silicone implants and divided them into the E-NSM group (20 patients) and the C-NSM group (25 patients), depending on the use of the endoscopic device.We also analyzed demographic information, pathology, operative time, and complications. @*Results@#No significant differences were observed between the 2 groups based on demographic information, postoperative pathological data, mean length of hospital stay, and total number of complications. The mean preparation time for surgery was comparable between both groups. Compared to the C-NSM group, the E-NSM group had a significantly longer mean operative time and, subsequently, a significantly longer mean total operative time and number of complications. @*Conclusion@#The results showed that E-NSM was feasible and safe with a more inconspicuous incision in patients with breast cancer.

Comparison of Single Incision Endoscopic Nipple-Sparing Mastectomy and Conventional NippleSparing Mastectomy for Breast Cancer Based on Initial Experience / 한국유방암학회지

Purpose@#Endoscopic breast surgery for patients with breast cancer was introduced for its superior cosmetic outcomes; it was initially studied in the field of breast-conserving surgery and, more recently, in robotic-assisted nipple-sparing mastectomy (NSM). The main purpose of this study was to investigate the feasibility and safety of endoscopic NSM (E-NSM) in patients with breast cancer by comparing E-NSM and conventional NSM (C-NSM). @*Methods@#Between May 2017 and October 2020, we retrieved the records of 45 patients who underwent NSM with permanent silicone implants and divided them into the E-NSM group (20 patients) and the C-NSM group (25 patients), depending on the use of the endoscopic device.We also analyzed demographic information, pathology, operative time, and complications. @*Results@#No significant differences were observed between the 2 groups based on demographic information, postoperative pathological data, mean length of hospital stay, and total number of complications. The mean preparation time for surgery was comparable between both groups. Compared to the C-NSM group, the E-NSM group had a significantly longer mean operative time and, subsequently, a significantly longer mean total operative time and number of complications. @*Conclusion@#The results showed that E-NSM was feasible and safe with a more inconspicuous incision in patients with breast cancer.

Extent of central lymph node dissection for papillary thyroid carcinoma in the isthmus

PURPOSE: The incidence of papillary thyroid carcinoma (PTC) arising from the isthmus is low; however, these tumors have aggressive clinical and pathological features. Moreover, the existing guidelines regarding the extent of surgery for this type of tumor are unclear. METHODS: This study enrolled 282 patients who underwent total thyroidectomy with bilateral central lymph node dissection. The patients were divided into 2 groups based on the location of the median line of the PTC. Group I included patients in whom the median line was located between the lateral margins of the trachea; group II included all others. We compared the 2 groups and conducted a multivariate analysis to assess risk factors for contralateral node metastasis from a PTC arising from the isthmus. RESULTS: Patients in group I had significantly higher frequencies of extrathyroidal extension and central lymph node metastasis. Group I also had a higher frequency of contralateral node metastasis, and a tumor size >1.0 cm was identified as an independent risk factor for contralateral node metastasis among patients in this group. CONCLUSION: Bilateral central lymph node dissection could be considered for patients with isthmic PTCs >1.0 cm in size who have clinically suspicious node metastasis.

Significance of micrometastases in the calculation of the lymph node ratio for papillary thyroid cancer

PURPOSE: The lymph node ratio (LNR) is an important prognostic factor in papillary thyroid carcinoma (PTC), but micrometastases in cervical lymph nodes (LNs) are not of great clinical importance. In this study, we analyzed the accuracy of prediction of the prognosis depending on whether micrometastases were included in the number of metastatic LNs when calculating LNR. METHODS: The study included 353 PTC patients who underwent total thyroidectomy with neck LN dissection, and calculated LNR by 2 methods according to whether micrometastases were included in the number of metastatic LNs: Method 1 did not and method 2 did include. To compare the predictive values of LNR by the 2 methods, correlation coefficients and receiver operating characteristic (ROC) curves were analyzed. RESULTS: Positive correlations were found between LNR and preablation stimulated thyroglobulin (sTg) levels in both methods, but the correlation between method 1 LNR and preablation sTg level was significantly stronger than that for method 2 (Fisher z = 1.7, P = 0.045). The areas under these 2 independent ROC curves were analyzed; the prognostic efficacy of method 1 LNR was more accurate than that of method 2 LNR, and the difference was statistically significant (P = 0.0001). CONCLUSION: Regional recurrence of PTC can be predicted more accurately by not including micrometastases in the number of metastatic LNs when calculating LNR.

Fulminant course in a case of malignant phyllodes tumor

We present the case of a 31-year-old woman with an inflammatory and ulcerative malignant phyllodes tumor in her right breast. A right modified radical mastectomy and transverse rectus abdominis myocutaneous (TRAM) flap were performed. A month after the initial operation, several masses recurred at the superior margin and deep margin of the TRAM flap. Wide excision was performed, but masses recurred at the inferior margin and in both lung fields 2 weeks after the second operation. Six weeks after the second operation, the patient died due to progression of dyspnea and respiratory failure.

Safety and Efficacy of Early Steroid Withdrawal with Thymoglobuline Induction in Kidney Transplantation / 대한이식학회지

BACKGROUND: We report our experiences of early steroid withdrawal using thymoglobuline induction in kidney transplant patients to verify the efficacy and safety of steroid minimization protocol that can prevent long term complications of steroid. METHODS: From December 2002 to July 2007, 36 kidney transplants were performed at our institution using the steroid early withdrawal protocol with 5 doses induction of thymoglobuline (50 mg IV), and maintaining with tacrolimus/ cyclosporine and mycophenolate mofetil (MMF)/azathioprine. Control group was 80 kidney transplant recipients on conventional triple immunosuppression protocol without antibody induction. RESULTS: Donor and recipient's profiles in both groups were not different except more proportion of diabetic patients and immunosuppression using tacrolimus and MMF in PD free group. The rejection rate was 13.8% and 16.3% in PD free and PD groups respectively. Two years graft and patients survival rate were 96.4%/100% in PD free group and 97.5%/97.5% in PD group. Serum creatinine level was similar between the two groups and WBC count was lower in PD free group up to postoperative 6 months. 72.2% of PD free group remained steroid free by the last follow up. CONCLUSIONS: Early steroid withdrawal with thymoglobulin induction can be applied safely with acceptable success rate with minimizing adverse effects of steroid in kidney transplantation patients. But early steroid withdrawal protocol should be adopted cautiously in immunologically high risk patients.

Biochemical Bone Markers in Postmenopausal Women with Hormone Replacement Therapy / 대한산부인과학회잡지

OBJECTIVES: To investigate the patterns of biochemical bone markers, such as urinary deoxypyridinoline (DPD), N-telopeptide of type I collagen (NTX), and serum osteocalcin (OC), bone-specific alkaline pbosphatase (BSAP) in postmenopansal women with hormone replacement therapy (HRT). Materials and METHOD: From July 1997 to January 1998, total 239 postmenopausal women were emolled in the present study, and 198 healthy premenopausal women with regular menstruation were served as control. The postmenopausal women were pouped into the HRT group and the non-HRT group. The women in the HRT poup have received estrogen with continuous or cyclic progestin therapy far more tban 6 months. The biochemical bone markers of all women were assayed. Results were analysed with Students t-test. RESULTS: The urinary DPD of the non-HRT group was sigaificantly higher than both the HRT poup and the premenopausal group(5.51 +/- 2.47 vs. 3.36 +/- 1.02 and 4.01 +/- 3.86 nM/mM, p < 0.05, repectively). The urinary NTX of the non-HRT group was also higher in comparison to the HRT group and the premenopausal group(48.71 +/- 11.54 vs. 33.70 +/- 17.43 and 33.70 +/- 17.43 nM BCE/mmol, p < 0.05, repectively). However, there were no significant differences in the concentrations of serum BSAP and OC among the three poups. CONCLUSION: The urinary DPD and NTX were more sensitive indicators of bone metabolism tban serum BSAP and OC in postmenopausal women undergoing HRT.

Clinical and Pathologic Characteristics of Uterine Sarcoma / 대한부인종양콜포스코피학회잡지

Uterine sarcomas are rare, characterized by rapid clinical progression and poor prognosis, and their management has been a challenge. The purpose of this study was to investigate the clinical and pathologic characteristics of patients with uterine sarcoma managed in the department of Obstetric and Gynecology, college of medicine, University of Ulsan, Asan Medical center, Seoul, Korea from June 1989 to August 1998. Data including clinical and histologic findings, treatment and outcome of nineteen patients were evaluated. The age of patients ranged 22 to 71 years (mean+/-S.D.; 46.9+/-13.1) and half of patients were postmenopausal and four patients were nulliparous. Palpable pelvic mass or abnormal uterine bleeding were the most common sign or symptom. Twelve patients (63.2%) had stage I disease and seven (36.8%) had stage III disease. There were 13 cases (68.4%) of leiomyosarcoma, 4 cases (21.1%) of endometrial stromal sarcoma, 2 cases (10.5%) malignant mixed mullerian tumor. All except one received hysterectomy (simple or radical) with or without bilateral salpingo-oophorectomy. Some received omentectomy or pelvic lymphadenectomy. Postoperative chemotherapy was administered in ten patients with regimen of VAC, VBP, VIC and etc. The mean follow-up duration was 29.3 (+/- 24.7) months and 5 patients died of the disease resulting 2-year survival of 68.1%. FIGO stage and mitotic count were considered to have prognostic significance, but without statistical confirmation. In conclusion, uterine sarcomas are aggressive tumors with a poor prognosis. Our data showed excellent outcome in early disease with surgery with or without adjuvant chemotherapy, whereas there was no long-term survivor in advanced disease despite postoperative chemotherapy.

An analysis of 78 cases of tubal ligation rebersals / 대한산부인과학회잡지

No abstract available.