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MP12-10 THE LEARNING CURVE OF RETROPERITONEAL LAPAROSCOPIC ADRENALECTOMY
THE JOURNAL OF UROLOGYâ
Vol. 195, No. 4S, Supplement, Friday, May 6, 2016
including suitable trocar configuration/angulation. The retroperitoneal approach performed via da Vinci robotic system can be applied for a variety of adrenal indications safely and effectively, with the potential of yielding better outcomes than LPRAA.
e129
open surgery was 1.6%. Depend on the side of the operation, no significant difference were observed in operation time (Lt 177min, Rt 182min, P¼0.235), while significant difference were observed in amount of bleeding (Lt 99ml, Rt 42ml, P¼0.0436). When divide generation of operator by 5 years, although no significant difference were observed in operation time(175-187min), amount of bleeding significantly reduced by the generation, such as for 1st, 2nd, 3ird, 4irth generation was, 166, 81, 38 and 41 ml. In terms of cases need to be stabilize, most significant cutoff was first 20 cases. The mean operation time significantly decreased by 21 min before and after 20 cases (196min and 175min, respectively) (P¼0.0043). On the other hand, the mean operation time of each surgeon was not proportional to the number of operations the surgeon had performed. CONCLUSIONS: Although the learning curves of laparoscopic adrenalectomy differed by surgeon, 20 cases seems to be a cut-off to acquire stable surgical skills.
Source of Funding: None
MP12-11 A NOVEL PATHOLOGY RELATED TO SUBCAPSULAR ALDOSTERONE-PRODUCING CELL CLUSTERS CAUSES HYPERALDOSTERONISM
Source of Funding: Chinese NSFC Grant 81460389 (to Gongxian Wang)
MP12-10 THE LEARNING CURVE OF RETROPERITONEAL LAPAROSCOPIC ADRENALECTOMY Shinichi Sakamoto*, Hiroto Kato, Masayasu Sugiyama, Kei Yoneda, Haruki Baba, Tomokazu Sazuka, Koji Kawamura, Takashi Imamoto, Naoki Nihei, Tomohiko Ichikawa, Chiba, Japan INTRODUCTION AND OBJECTIVES: The development of laparoscopic skills requires experience with a certain number of cases. The learning curve of the surgeon in acquiring laparoscopic skills was examined in over 300 cases of retroperitoneal laparoscopic adrenalectomy. METHODS: The study included 318 retroperitoneal laparoscopic adrenal tumor cases performed between 2006 and 2015 at Chiba University Hospital. Duration of operation, bleeding, and complications were analyzed by review of the operation records. MannWhitney U test and Student t-test were used for statistical analysis. RESULTS: The mean age of patients was 55 (22-78) years. There were 183 left(Lt) and 133 right(Rt) adrenal tumors. Average tumor size was 23 (0-115) mm. Clinical manifestations included primary aldosteronism(APA) (129 cases), Cushing syndrome (49 cases), subclinical Cushing syndrome(SCS) (68 cases), APA+SCS(20 cases), pheochromocytoma (10 cases), and other tumors (43 cases). The median operation time was 168 minutes (min). The conversion rate to
Koshiro Nishimoto*, Tachikawa, Japan; Tsugio Seki, Colton, CA; Isao Kurihara, Kenichi Yokota, Shinjuku, Japan; Masao Omura, Tetsuo Nishikawa, Yokohama, Japan; Hirotaka Shibata, Oita, Japan; Takeo Kosaka, Mototsugu Oya, Makoto Suematsu, Kuniaki Mukai, Tokyo, Japan INTRODUCTION AND OBJECTIVES: We previously reported that the human adrenal cortex remodels to form subcapsular aldosterone-producing cell clusters (APCCs), which strongly express aldosterone synthase (CYP11B2) (Nishimoto et al., JCEM 2010;95,2296-305). Furthermore, Nishimoto et al. found that some APCCs carry aldosterone-producing adenoma (APA)-associated somatic mutations in ion channel/pump genes, which imply that APCCs produce aldosterone autonomously and are an origin of APA (PNAS 2015;112,E4591-9). In this study, we aimed to characterize possible APCC-to-APA trasitional lesions (pAATLs, a tentative term used in this abstract). METHODS: We seeked pAATLs in non-adenomatous adrenals causing primary aldosteronism (PA), and characterized localization of APA-associated mutations in these pAATLs. RESULTS: We identified unilateral multiple micronodules in the adrenals from two PA patients. Based on immunohistochemistry for CYP11B2, some of the micronodules were identified as pAATLs, which consisted of a subcapsular APCC-like portion and inner micro-APA-like (mAPA-like) portion without an apparent histological border. Genomic DNA samples prepared from pAATL histological sections were analyzed by next generation sequencing (NGS) for the known APAassociated mutations. The mAPA-like portions of two out of the three large pAATLs examined harbored mutations (KCNJ5 [p.G151R] in pAATL#3 and ATP1A1 [p.L337M] in pAATL#7), while their corresponding APCC-like portions did not, suggesting their role in the formation of mAPA. Another lesion carried novel mutations in ATP1A1 [p.Ile322_Ile325del and p.Ile327Ser] in both the mAPA-like and APCClike portions, thereby supporting these portions having a clonal origin.
Vol. 195, No. 4S, Supplement, Friday, May 6, 2016
including suitable trocar configuration/angulation. The retroperitoneal approach performed via da Vinci robotic system can be applied for a variety of adrenal indications safely and effectively, with the potential of yielding better outcomes than LPRAA.
e129
open surgery was 1.6%. Depend on the side of the operation, no significant difference were observed in operation time (Lt 177min, Rt 182min, P¼0.235), while significant difference were observed in amount of bleeding (Lt 99ml, Rt 42ml, P¼0.0436). When divide generation of operator by 5 years, although no significant difference were observed in operation time(175-187min), amount of bleeding significantly reduced by the generation, such as for 1st, 2nd, 3ird, 4irth generation was, 166, 81, 38 and 41 ml. In terms of cases need to be stabilize, most significant cutoff was first 20 cases. The mean operation time significantly decreased by 21 min before and after 20 cases (196min and 175min, respectively) (P¼0.0043). On the other hand, the mean operation time of each surgeon was not proportional to the number of operations the surgeon had performed. CONCLUSIONS: Although the learning curves of laparoscopic adrenalectomy differed by surgeon, 20 cases seems to be a cut-off to acquire stable surgical skills.
Source of Funding: None
MP12-11 A NOVEL PATHOLOGY RELATED TO SUBCAPSULAR ALDOSTERONE-PRODUCING CELL CLUSTERS CAUSES HYPERALDOSTERONISM
Source of Funding: Chinese NSFC Grant 81460389 (to Gongxian Wang)
MP12-10 THE LEARNING CURVE OF RETROPERITONEAL LAPAROSCOPIC ADRENALECTOMY Shinichi Sakamoto*, Hiroto Kato, Masayasu Sugiyama, Kei Yoneda, Haruki Baba, Tomokazu Sazuka, Koji Kawamura, Takashi Imamoto, Naoki Nihei, Tomohiko Ichikawa, Chiba, Japan INTRODUCTION AND OBJECTIVES: The development of laparoscopic skills requires experience with a certain number of cases. The learning curve of the surgeon in acquiring laparoscopic skills was examined in over 300 cases of retroperitoneal laparoscopic adrenalectomy. METHODS: The study included 318 retroperitoneal laparoscopic adrenal tumor cases performed between 2006 and 2015 at Chiba University Hospital. Duration of operation, bleeding, and complications were analyzed by review of the operation records. MannWhitney U test and Student t-test were used for statistical analysis. RESULTS: The mean age of patients was 55 (22-78) years. There were 183 left(Lt) and 133 right(Rt) adrenal tumors. Average tumor size was 23 (0-115) mm. Clinical manifestations included primary aldosteronism(APA) (129 cases), Cushing syndrome (49 cases), subclinical Cushing syndrome(SCS) (68 cases), APA+SCS(20 cases), pheochromocytoma (10 cases), and other tumors (43 cases). The median operation time was 168 minutes (min). The conversion rate to
Koshiro Nishimoto*, Tachikawa, Japan; Tsugio Seki, Colton, CA; Isao Kurihara, Kenichi Yokota, Shinjuku, Japan; Masao Omura, Tetsuo Nishikawa, Yokohama, Japan; Hirotaka Shibata, Oita, Japan; Takeo Kosaka, Mototsugu Oya, Makoto Suematsu, Kuniaki Mukai, Tokyo, Japan INTRODUCTION AND OBJECTIVES: We previously reported that the human adrenal cortex remodels to form subcapsular aldosterone-producing cell clusters (APCCs), which strongly express aldosterone synthase (CYP11B2) (Nishimoto et al., JCEM 2010;95,2296-305). Furthermore, Nishimoto et al. found that some APCCs carry aldosterone-producing adenoma (APA)-associated somatic mutations in ion channel/pump genes, which imply that APCCs produce aldosterone autonomously and are an origin of APA (PNAS 2015;112,E4591-9). In this study, we aimed to characterize possible APCC-to-APA trasitional lesions (pAATLs, a tentative term used in this abstract). METHODS: We seeked pAATLs in non-adenomatous adrenals causing primary aldosteronism (PA), and characterized localization of APA-associated mutations in these pAATLs. RESULTS: We identified unilateral multiple micronodules in the adrenals from two PA patients. Based on immunohistochemistry for CYP11B2, some of the micronodules were identified as pAATLs, which consisted of a subcapsular APCC-like portion and inner micro-APA-like (mAPA-like) portion without an apparent histological border. Genomic DNA samples prepared from pAATL histological sections were analyzed by next generation sequencing (NGS) for the known APAassociated mutations. The mAPA-like portions of two out of the three large pAATLs examined harbored mutations (KCNJ5 [p.G151R] in pAATL#3 and ATP1A1 [p.L337M] in pAATL#7), while their corresponding APCC-like portions did not, suggesting their role in the formation of mAPA. Another lesion carried novel mutations in ATP1A1 [p.Ile322_Ile325del and p.Ile327Ser] in both the mAPA-like and APCClike portions, thereby supporting these portions having a clonal origin.