出版者・発行元：Current Urology  

Background We assessed the feasibility of a new probe attachment (PA) developed to improve the ease of holding the drop-in-type L43K ultrasound probe during robot-assisted partial nephrectomy. Materials and methods We retrospectively analyzed the outcomes of 58 patients after robot-assisted partial nephrectomy using the conventional grip and 13 patients after surgery using the PA between September 2019 and February 2021. Propensity score matching (1:1) was performed to adjust for potential baseline confounders. The usability of the PA was evaluated regarding (1) total procedure time for intraoperative laparoscopic ultrasound; (2) proportion rate of intraoperative laparoscopic ultrasound in console time; (3) total number of probe fin grips; (4) total number of grip failures; (5) intraoperative laparoscopic ultrasound procedure time per grip; and (6) rate of successful gripping. Results After matching, 12 patients were allocated to each group, and the tumor site was significantly different between the groups. Usability was significantly better in the PA group: (1) conventional versus PA: 6.8 versus 7.6, p = 0.53; (2) 5.6% versus 6.1%, p = 0.61; (3) 8 versus 10, p = 0.32; (4) 3 versus 0, p = 0.014; and (5) 1.5% versus 0.7%, p = 0.021; (6) 66% versus 100%, p = 0.002. In patients with complex renal tumors, completely endophytic tumors, and renal hilum tumors, nearly identical improvements in usability were observed: (1) 9.8 versus 7.8 min, p = 0.21; (2) 9.9% versus 4.7%, p = 0.001; (3) 7 versus 6, p = 0.025; (4) 3 versus 0, p = 0.048, (5) 2.9 versus 1.6 min, p = 0.89, and (6) 60% versus 100%, p = 0.003. Conclusions Our proposed L43K PA can enhance the usability of the probe for intraoperative laparoscopic ultrasonography during robot-assisted partial nephrectomy and increase the accuracy of ultrasonography for complex renal tumors.

DOI： 10.1097/CU9.0000000000000274

Scopus

記述言語：英語   出版者・発行元：Annals of surgical oncology  

BACKGROUND: This study aimed to show the association between tumor location and laterality of positive lymph nodes by evaluating biopsy and magnetic resonance imaging (MRI) findings, and to optimize the extended pelvic lymph node dissection (ePLND) side for prostate cancer. METHODS: The study enrolled patients who underwent robot-assisted radical prostatectomy with ePLND. Tumor locations were determined according to International Society of Urological Pathology grade group 4/5 in biopsies and Prostate Imaging-Reporting and Data System category 4/5 in MRI results. The concordance of tumor location lobe and positive lymph node side with the performance of tumor location-guided ePLND for positive lymph node detection was evaluated. RESULTS: For 301 patients who underwent ePLND at Kyushu University Hospital, tumor locations determined by biopsy and MRI findings showed no lesion in 8 (2.7%) patients, unilateral lobe in 223 (74.1%) patients, and bilateral lobe in 70 (23.3%) patients. The accuracies for detection of any and all positive lymph nodes by tumor location-guided unilateral ePLND were 99.6% and 97.3%, respectively. Among the patients at St. Luke's International Hospital, the accuracies for detection of any and all positive lymph nodes by tumor location-guided unilateral ePLND were estimated to be 99.0% and 97.3%, respectively. CONCLUSIONS: This study proposed tumor location-guided ePLND according to biopsy and MRI findings. This novel strategy is expected to reduce the burden of bilateral ePLND at the cost of acceptable risk of failing to detect positive lymph nodes.

DOI： 10.1245/s10434-024-16294-6

Web of Science

Scopus

PubMed

記述言語：英語   出版者・発行元：Journal of Robotic Surgery  

Our objective was to investigate the long-term functional outcomes of robot-assisted partial nephrectomy (RAPN) combined with three-dimensional (3D) imaging. The 3D images, reconstructed using computed tomography, were introduced in RAPN procedures. The demographic, oncological, functional, and volumetric outcomes of 296 patients who underwent RAPN with and without 3D imaging between 2013 and 2021 were analyzed retrospectively. Propensity score matching (1:1) was performed to adjust for potential baseline confounders. After matching, 71 patients were allocated to each group. In the 3D RAPN (3DRPN) group, functional outcomes significantly improved: the number of patients with over 90% estimated glomerular filtration rate (eGFR) preservation rate (40 vs. 43, P = 0.044), eGFR preservation rate (88.0% vs. 91.6%, P = 0.006), the number of patients with chronic kidney disease (CKD) upstaging (26 vs. 13, P = 0.023), and split renal function preservation rate (operated kidney: 84.9% vs. 88.5%, P = 0.015). The 3DRPN group showed superiority in terms of >90% eGFR preservation (P = 0.010), CKD upstaging-free survival rates (P < 0.001), and volumetric outcomes (excess parenchymal volume: 27.9 vs. 17.7 mL, P = 0.030; parenchyma volume preservation rate: 81.6% vs. 88.8%, P = 0.006). Three-dimensional imaging was positively associated with eGFR preservation (P = 0.023, odds ratio: 2.34) and prevention of CKD upstaging (P = 0.013, odds ratio: 2.90). In this study, RAPN combined with 3D imaging underscored the preservation of eGFR > 90% and the prevention of CKD upstaging by improving the preservation rate of renal parenchyma and split renal function.

DOI： 10.1007/s11701-024-02070-x

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PubMed

記述言語：英語   出版者・発行元：International Journal of Clinical Oncology  

In the last decade, the standard treatment for advanced renal cell carcinoma (RCC) has evolved, mainly driven by the development and approval of immune checkpoint inhibitors (ICIs). Currently, ICI monotherapy and ICI-based combinations with tyrosine kinase inhibitors and targeted therapies against mammalian target of rapamycin or vascular endothelial growth factor have become new standard treatments for first-line and subsequent-line therapies. ICIs play an important role as an adjuvant postoperative therapy, and this field is the subject of active research. Furthermore, ongoing randomized controlled trials are investigating the clinical value of more intense treatments by combining multiple effective treatments for RCC. Additionally, novel biomarkers for prognosis have been investigated. This study reviews the current evidence on immunotherapy as a treatment for RCC patients, randomized controlled trials, and ongoing studies including RCC patients and recent findings, and discusses future perspectives.

DOI： 10.1007/s10147-023-02446-3

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PubMed

記述言語：英語   出版者・発行元：John Wiley & Sons Australia, Ltd  

根治的前立腺摘除術(RP)後に行う前立腺特異抗原(PSA)モニタリングの4つのモデルの妥当性を検証し、生化学的再発(BCR)検出を改善する修正モデルを検討した。2009～2022年にロボット支援RPを受けた患者の臨床病理学的データを調べ、4つのモデルで仮想上経過観察時のPSA値を推定した。BCR検出に最適なPSA値は0.2～0.4ng/mLと定義した。患者896例(年齢中央値66歳)を解析した。追跡期間中央値21.4ヵ月の間に128例(14.3%)がBCRを認めた。BCRが検出されたPSA値0.4ng/mL超の患者は、慶應モデル、修正慶應モデル、国立がん研究センター中央病院(NCCH)モデル、および米国泌尿器科学会(AUA)/米国放射線腫瘍学会(ASTRO)モデルでそれぞれ14例(10.9%)、3例(2.3%)、12例(9.4%)、および11例(8.6%)であった。殆どの患者は、術後1年目にPSA値0.4ng/mL超でBCRが検出された。術後6ヵ月以内の間隔に変更すると、術後1年以内のPSA>0.4ng/mLのBCR検出は上記のモデルそれぞれで8/9例(88.9%)、1/2例(50.0%)、5/6(83.3%)、4/4例(100%)で回避された。以上より、RP後のBCR検出のためのPSAモニタリングを最適にするための修正案が示唆された。

記述言語：英語   出版者・発行元：International Journal of Urology  

Background: Early detection of biochemical recurrence (BCR) after radical prostatectomy (RP) is crucial for early treatment and improving survival outcomes. The optimal prostate-specific antigen (PSA) monitoring remains unclear, and several models have been proposed. We aimed to externally validate four models for optimal PSA monitoring after RP and propose modifications to improve them. Methods: We reviewed the clinicopathological data of 896 patients who underwent robot-assisted RP between 2009 and 2022. We examined all PSA values and estimated the PSA value for four monitoring schedules at each time point in the virtual follow-up. We defined the ideal PSA for BCR detection between 0.2 and 0.4 ng/mL. Results: During the median follow-up of 21.4 months, 128 (14.3%) patients presented BCR. The original and modified Keio models, National Cancer Center Hospital model, and American Urological Association/American Society for Radiation Oncology model detected BCR in 14 (10.9%), three (2.3%), 12 (9.4%), and 11 (8.6%) patients with PSA >0.4 ng/mL. Most patients experienced BCR detected with PSA >0.4 ng/mL during the first year postoperative. The modification of interval within 6 months postoperative avoided BCR detection with PSA >0.4 ng/mL within the first year postoperative in 8/9 (88.9%), 1/2 (50.0%), 5/6 (83.3%), and 4/4 (100%) for the original and modified Keio models, National Cancer Center Hospital model, and American Urological Association/American Society for Radiation Oncology model, respectively. Conclusion: We validated four models for PSA monitoring after RP to detect BCR and suggested modifications to avoid detections out of the desired range of PSA. These modifications could help to establish an optimal PSA monitoring schedule after RP.

DOI： 10.1111/iju.15379

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   出版者・発行元：Journal of Robotic Surgery  

The novel technique of lateral pelvic fascia preservation (LPFP) in robot-assisted radical prostatectomy (RARP) has been reported to improve urinary continence recovery. We aimed to investigate surgical and oncological outcomes after RARP using the LPFP technique and compare them with conventional RARP. This study included patients who underwent RARP with and without the LPFP technique. Time to urinary continence recovery was compared between the LPFP and non-LPFP groups using univariate, multivariate, and propensity-score matched analysis. Perioperative and postoperative outcomes were compared between the two groups using univariate analysis. We included 139 patients who underwent RARP, 68 in the LPFP group and 71 in the non-LPFP group. The LPFP technique was associated with a shorter time to urinary continence recovery, a shorter operative time and lower estimated blood loss. Surgical and oncological outcomes, including complications, pathological T-stage, surgical margin status, and biochemical recurrence-free survival, were comparable between the two groups. This study demonstrated that the LPFP technique improves urinary continence recovery and operative times without compromising surgical and oncological outcomes. The use of this technique in patients with clinically localized prostate cancer is recommended.

DOI： 10.1007/s11701-023-01702-y

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記述言語：日本語   出版者・発行元：公益社団法人 日本生体医工学会  

<p>【背景】膀胱癌は経尿道手術後に再発が多い腫瘍であり、膀胱鏡での腫瘍の見落としが原因とされている。内視鏡での観察は、従来の白色光(WLI)の他に、NBIを使用するが、いずれの腫瘍検出精度は検者の技量・経験に依存するため、検査の再現性・客観性が少ないことが課題である。近年、人工知能(AI)が多くの医療分野で活用されており、AIによる検査は、客観性・再現性を持った上で、エキスパートレベルと同程度の診断能を持つ可能性があるとされている。今回、WLI/NBI膀胱鏡画像を用いて、AIによる腫瘍検出の精度を検証した。【方法】2019年から2021年まで、経尿道的膀胱腫瘍切除術(TURBT)の際に、WLI/NBIを用いて観察を行った症例の手術動画から膀胱鏡画像を作成し、腫瘍を含む画像を腫瘍画像、腫瘍を含まない画像を正常画像と定義した。腫瘍画像内の膀胱腫瘍を矩形でアノテーションを行い、テストデータ用の画像を用いてAIによる感度、特異度、陽性的中率を評価した。AIでの物体検出はtiny-YOLOを用い、腫瘍検出精度の検証を行った。【結果】WLIとNBIから、それぞれ腫瘍画像をそれぞれtiny-YOLOで学習を行い、腫瘍画像(WLI: 525枚、NBI:219枚)と正常画像(WLI:98枚、NBI:108枚)で精度検証を行った。AIによる物体検出の感度/特異度/陽性的中率は、WLIで87.8%/88.8%/97.7%、NBIで82.2%/81.4%/90.0%であった。【結論】膀胱鏡画像において、AIにより比較的良好に腫瘍検出が可能であった。更なる精度改善、リアルタイム検出への課題について、文献的考察を加え報告する。</p>

DOI： 10.11239/jsmbe.annual61.255_2

CiNii Research

記述言語：英語   出版者・発行元：Journal of Endourology  

Background: Early intravesical recurrence after transurethral resection of bladder tumors (TURBT) is often caused by overlooking of tumors during TURBT. Although narrow-band imaging and photodynamic diagnosis were developed to detect more tumors than conventional white-light imaging, the accuracy of these systems has been subjective, along with poor reproducibility due to their dependence on the physician's experience and skills. To create an objective and reproducible diagnosing system, we aimed at assessing the utility of artificial intelligence (AI) with Dilated U-Net to reduce the risk of overlooked bladder tumors when compared with the conventional AI system, termed U-Net. Materials and Methods: We retrospectively obtained cystoscopic images by converting videos obtained from 120 patients who underwent TURBT into 1790 cystoscopic images. The Dilated U-Net, which is an extension of the conventional U-Net, analyzed these image datasets. The diagnostic accuracy of the Dilated U-Net and conventional U-Net were compared by using the following four measurements: pixel-wise sensitivity (PWSe); pixel-wise specificity (PWSp); pixel-wise positive predictive value (PWPPV), representing the AI diagnostic accuracy per pixel; and dice similarity coefficient (DSC), representing the overlap area between the bladder tumors in the ground truth images and segmentation maps. Results: The cystoscopic images were divided as follows, according to the pathological T-stage: 944, Ta; 412, T1; 329, T2; and 116, carcinoma in situ. The PWSe, PWSp, PWPPV, and DSC of the Dilated U-Net were 84.9%, 88.5%, 86.7%, and 83.0%, respectively, which had improved when compared to that with the conventional U-Net by 1.7%, 1.3%, 2.1%, and 2.3%, respectively. The DSC values were high for elevated lesions and low for flat lesions for both Dilated and conventional U-Net. Conclusions: Dilated U-Net, with higher DSC values than conventional U-Net, might reduce the risk of overlooking bladder tumors during cystoscopy and TURBT.

DOI： 10.1089/end.2021.0483

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PubMed

記述言語：日本語   出版者・発行元：(一社)日本泌尿器内視鏡・ロボティクス学会  

ロボット支援腎部分切除術の術中超音波検査は,腎腫瘍を確実に切除するために必須である.術中超音波検査に用いられるL43Kプローブは,この術式に使用される超音波プローブの1つであり,術中はフェネストレイテッド鉗子でプローブのフィンを把持して使用する.RAPNは狭い後腹膜腔で鉗子を使ってプローブを操作しなければならず,プローブ先端からフィンを把持することが頻回にあった.このフィンはプローブ先端に向かって傾斜が低くなりかつ放射状に広がっている構造のため,プローブ先端から把持できない設計になっている.これが原因でプローブ先端からの把持は安定せず,プローブを頻回に落としていた.今回我々はプローブの先端から把持しづらい課題に対して,医工連携を通してプローブアタッチメントを開発して解決したので報告する.(著者抄録)

記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器内視鏡・ロボティクス学会  

<p>　ロボット支援腎部分切除術の術中超音波検査は, 腎腫瘍を確実に切除するために必須である. 術中超音波検査に用いられるL43Kプローブは, この術式に使用される超音波プローブの1つであり, 術中はフェネストレイテッド鉗子でプローブのフィンを把持して使用する. RAPNは狭い後腹膜腔で鉗子を使ってプローブを操作しなければならず, プローブ先端からフィンを把持することが頻回にあった. このフィンはプローブ先端に向かって傾斜が低くなりかつ放射状に広がっている構造のため, プローブ先端から把持できない設計になっている. これが原因でプローブ先端からの把持は安定せず, プローブを頻回に落としていた. 今回我々はプローブの先端から把持しづらい課題に対して, 医工連携を通してプローブアタッチメントを開発して解決したので報告する.</p>

DOI： 10.11302/jserjje.35.1_109

CiNii Research

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記述言語：日本語   出版者・発行元：(有)科学評論社  

記述言語：日本語   出版者・発行元：日本腎泌尿器疾患予防医学研究会