Feasibility and safety of transvaginal specimen extraction for laparoscopic living donor nephrectomy: An Indonesian perspective compared with three different approaches.

INTRODUCTION: Laparoscopic live donor nephrectomy (LLDN) continues to expand in minimally invasive surgery; nevertheless, the studies are inadequate to compare standard kidney extraction with TV-NOSE in less-developed countries. This study compared TV-NOSE with conventional kidney specimen extractions. OBJECTIVE: To examine the feasibility of TV-NOSE in live donor nephrectomy. MATERIALS AND METHODS: 53 patients received LDN surgery at our hospital from September 2017 to December 2021. Retrospectively, living donor nephrectomy with TV-NOSE was compared to three different surgical procedures with standard specimen extraction. RESULTS: 53 donor patients were included: 15 open (OLDN), 12 retroperitoneoscopic living donor nephrectomy (RPLDN), 10 transperitoneal living donor nephrectomy (TPLDN), and 16 standard laparoscopic living donor nephrectomy with transvaginal extraction (SLLDN TV-NOSE). SLLDN TVNOSE's longer operating time (p<0.0041) did not affect graft function. SLLDN TV-NOSE and RPLDN had shorter lengths of stay and better VAS trends than open LDN and TPLDN (p<0.05). SLLDN TV-NOSE donors reported acceptable surgical outcomes and unchanged sexual function. All patients had similar discharge creatinine levels, with 1-year transplant survival of 98% and just 1 graft loss in the TPLDN group. CONCLUSION: SLLDN TV-NOSE is equivalent to RPLDN and better than open LDN and TPLDN in terms of duration of stay, VAS score, surgical outcomes, and sexual function. TVNOSE is a safe surgical procedure with an acceptable donor complication. TV-NOSE may be safely conducted in both developed and developing countries with proper patient selection.

Toxicity profiling of 24 l-phenylalanine derived ionic liquids based on pyridinium, imidazolium and cholinium cations and varying alkyl chains using rapid screening Vibrio fischeri bioassay.

A library of 24 pyridinium-, imidazolium-, and cholinium-based ionic liquids (ILs) with varying alkyl chain from C2 to C16 was toxicologically profiled using naturally luminescent marine bacteria Vibrio fischeri. The toxicity (30-min EC50) of studied ILs to Vibrio fischeri ranged from 7.82 µM (4.2 mg/L) (PyC12Phe) to 3096 µM (1227 mg/L) (ImidC2Phe), i.e. from "toxic" (EC50 1-10 mg/L) to "not harmful" (EC50 > 100 mg/L). Inhibition of the bacterial luminescence upon 30-min exposure to ILs correlated well with bacterial viability (exposure for 4 h). The toxicity of studied ILs was largely driven by the length of the alkyl chain (hydrophobicity) and not the type of cationic part of the IL: starting from C10 all the ILs irrespective of the cationic part proved "toxic". The toxicity of the studied ILs was increasing in parallel to their hydrophobicity up to log Kow = 1 (C8-C10) and then levelling up, being consistent with the previously obtained analogous data sets. The "cut-off" effect reported in this study for longer chain length members of the ILs series leads to the "limit" toxicity level for this type of ILs to be ca. 8 mM. Two open-access online tools (www.molinspiration.com and www.vcclab.org) have been applied for the calculation of the Kow values for the 24 ILs reported in this study and 21 ILs reported in the literature. This lead to plotting two nonlinear monotonic correlations between the values of experimental log (1/EC50) and calculated log Kow. The limitation of the online tools and an effect of the ILs structure on the "cut-off" effect have been discussed. The challenge of developing low microbial toxicity surface active ILs remains a significant task to overcome. Our results shed light on the new approaches for designing environmentally benign ILs and functional surfactants. As the hydrophobicity of the ILs significantly correlated with the toxicity, the Vibrio fischeri assay could be considered a powerful tool in providing toxicity data for building and evaluating the QSAR toxicity models for ILs.

A case report: Addison disease caused by adrenal tuberculosis.

We report middle age man with skin hyperpigmentation oral and lip mucous membranes, general malaise and depression. Further examinations lead to adrenal insufficiency, Addison's disease. Imaging studies show bilateral adrenal hyperplasia, show negative result for tuberculosis. We perform laparoscopic adrenalectomy. Multiple caseosa necrosis in gross specimen and Langhan's giant cells microscopic appearance ensure patient suffered Addison's disease cause by adrenal gland tuberculosis.