Monthly oral ibandronate 100 mg is as effective as monthly intravenous ibandronate 1 mg in patients with various pathologies in the MOVEST study.

The non-inferiority of oral ibandronate 100 mg to intravenous (i.v.) ibandronate 1 mg in increasing lumbar spine (LS) bone mineral density (BMD) after 12 months of treatment was demonstrated in the randomized, phase III MOVEST study. We conducted subgroup analyses in the per-protocol set of the study (n = 183 oral ibandronate; n = 189 i.v. ibandronate). In patients with LS BMD T score ≥ -3.0 or < -3.0 at screening, LS BMD gains from baseline were 4.42 and 5.79%, respectively, with oral ibandronate, and 4.60 and 5.83%, respectively, with i.v. ibandronate. LS BMD gains in patients with or without prevalent vertebral fractures were 5.21 and 5.23%, respectively, with oral ibandronate, and 5.01 and 5.49%, respectively, with i.v. ibandronate. In patients aged <75 or ≥75 years, LS BMD gains were 5.46 and 4.51%, respectively, with oral ibandronate, and 5.25 and 5.77%, respectively, with i.v. ibandronate. LS BMD gains in patients with baseline 25-hydroxyvitamin D levels ≥20 or <20 ng/mL were 5.35 and 4.76%, respectively, with oral ibandronate, and 5.05 and 6.57%, respectively, with i.v. ibandronate. Similar results were obtained in patients with or without prior bisphosphonate (BP) treatment, and in those receiving osteoporosis drug treatment other than BPs. In conclusion, oral ibandronate 100 mg demonstrated comparable BMD gains with monthly i.v. ibandronate, and thus shows high utility in the lifestyle and disease conditions associated with osteoporosis in Japanese patients.

Hand-assisted, conventional and laparoendoscopic single-site surgery for partial nephrectomy without ischemia using a microwave tissue coagulator.

PURPOSE: We report our experience of minimally invasive partial nephrectomy without ischemia using a microwave tissue coagulator (MTC) for hand-assisted laparoscopic partial nephrectomy (HALPN), conventional laparoscopic partial nephrectomy (CLPN), and laparoendoscopic single-site surgery for partial nephrectomy (LESSPN). We retrospectively compared the results of these techniques to better define the individual role and the benefits. MATERIALS AND METHODS: From July 2005 to September 2012, 28 patients with small and exophytic renal tumors underwent HALPN (n = 12), CLPN (n = 10) and LESSPN (n = 6). In these procedures, the surgeon used an MTC for circumferential coagulation around the tumor. After coagulation, the tumor was resected without renal pedicle clamping. RESULTS: The mean operative time was 259, 194 and 174 min for the HALPN, CLPN and LESSPN groups respectively. Two patients (one in HALPN group and one in LESSPN group) converted to laparotomy due to an inability to maintain hemostasis; however, there were no conversions to ischemic partial nephrectomy or radical nephrectomy. No differences between HALPN, CLPN and LESSPN were noted in terms of estimated blood loss, measured analgesic requirements, outcomes, or complications. CONCLUSION: We believe that these techniques are feasible and that they minimize the risk of unexpected collateral thermal damage by appropriate MTC needle puncture. When deciding to use HALPN, CLPN or LESSPN, our findings suggest that the choice of surgical approach should depend on the patient's individual circumstance.

Retroperitoneoscopic nephrectomy for symptomatic hydronephrosis using a SAND balloon catheter.

INTRODUCTION: A retroperitoneoscopic nephrectomy (RN) for symptomatic hydronephrosis (SH) is a challenging procedure because of the limited working space. This report describes a specific technical modification for efficient and successful RN for SH by using the SAND balloon catheter. PATIENT AND METHODS: A 38-year-old woman underwent RN for SH caused by extrinsic compression of the ureter by a pelvic endometriosis. The SAND balloon catheter was directly inserted into the expanded hydronephrotic sac, and the liquid was extracted, appropriately. Urine leakage from the hydronephrotic sac could be avoided because the puncture site was sealed firmly between the two adjacent balloons at the tip of the catheter. Disposal counter traction using the catheter facilitated the mobilization of the hydronephrotic sac. RESULTS: The patient was discharged 3 days after undergoing this procedure. CONCLUSIONS: This method improves the surgeon's vision and facilitates resection without causing any injury to the hydronephrotic sac wall during RN.

Glove-assisted laparoscopic radical nephrectomy: a novel technique.

BACKGROUND: Laparoscopic surgery has not yet met with widespread acceptance due to its degree of technical difficulty. The laparoscopic radical nephrectomy procedure was improved with the aid of an abdominal wall sealing device, a wound retractor, and a surgical glove. METHODS: A 5 cm skin incision was made at the beginning of the operation. The Alexis wound retractor S was set up through this small incision. The wrist portion of the surgical glove (size 8-0) was then used to cover the outer ring of the wound retractor to maintain pneumoperitoneum. The surgeon can use most of the usual surgical instruments through the wound retractor during the laparoscopic surgery. RESULTS: These procedures were successfully conducted in all cases without open conversion, and no postoperative complications were observed. CONCLUSIONS: Glove-assisted laparoscopic surgery can be used to perform advanced laparoscopic procedures. This new technique made laparoscopic abdominal surgery easier and safer for beginners in laparoscopic surgery and skilled surgeons in open surgery.