Browsing by Author "Sirianan Prasit"

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    PublicationOpen Access
    Outcome of Robotic Assisted Laparoscopic Radical Prostatectomy: Initial Experience in Ramathibodi Hospital
    (2014) Jirachai Thimachai; Sirianan Prasit; Wisoot Kongchareonsombat; Kittinut Kijvikai; Pokket Sirisreetreerux; จิระชัย ธิมาชัย; ศิริอนันต์ ประสิทธิ์; วิสูตร คงเจริญสมบัติ; กิตติณัฐ กิจวิกัย; ปกเกศ ศิริศรีตรีรักษ์; Mahidol University. Faculty of Medicine Ramathibodi Hospital. Department of Surgery
    Background: Robotics assisted laparoscopic prostatectomy (RALRP) has been shown to improve functional outcomes when compared to open or laparoscopic prostatectomy with similar oncologic results. It has become a famous procedure for treating patients with localized prostate cancer. The program of RALRP has just been started at Ramathibodi Hospital for about a year. The feasibility of this procedure in our institution has to be established. Objective: To evaluate the feasibility of the RALRP that was performed early at Ramathibodi Hospital. Methods: Medical records of 30 patients with clinically localized prostate cancer who underwent RALRP by two laparoscopic-experienced urologists in Ramathibodi Hospital from May 2013 to January 2014 were retrospectively reviewed including outcomes, complications, and cost per admission for RALRP. Results: Mean operative time was 4.2 hours (range 2.0 – 7.3) and mean estimated blood loss was 527 mL (range 100 – 2200) without blood transfusion requirement in 80% of all patients. There were no intraoperative complications and no conversions to open surgery. Twenty-four patients (80%) had pT2 disease and 6 patients had pT3 disease. Positive surgical margin rate was 53%. There were 20% minor post-operative complications, and no major post-operative complications and mortalities. Mean length of hospital stay was 8 days (range 5 - 19) and mean duration of urethral catheter indwelling was 11 days (range 5 – 22). Mean post-operative serum PSA level was 0.08 ng/mL (range 0.00 - 1.12) with mean follow-up duration of 86 days. Total cost per admission for RALRP was 126,875 baht (range 50.968 - 343,027) Conclusions: RALRP for prostate cancer in Ramathibodi Hospital is safe but additional studies are needed to indicate the feasibility of this procedure.
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    R.E.N.A.L. nephrometry score in clinical stage T1 renal mass: Ramathibodi hospital experience
    (2015-01-01) Sirianan Prasit; Pokket Sirisreetreerux; Premsant Sangkum; Kittinut Kijvikai; Wit Viseshsindh; Wisoot Kongchareonsombat; Charoen Leenanupunth; Wachira Kochakarn; Mahidol University
    © 2015, Medical Association of Thailand. All rights reserved. Objective: The main treatment strategies for clinical stage T1 renal mass are radical nephrectomy (RN) and partial nephrectomy (PN). Treatment decision depends largely on tumor complexity as assessed by the R.E.N.A.L. nephrometry scoring system. The authors evaluated our experience with R.E.N.A.L. nephrometry score in all patients who underwent surgery. Material and Method: The authors evaluated 61 patients who presented with clinical stage T1 renal mass and underwent radical or partial nephrectomy between 2007 and 2013 at Ramathibodi Hospital. Tumor complexity was quantified by R.E.N.A.L. nephrometry score in all patients using preoperative imaging. Statistical analysis was done to study associations. Results: Sixty-one patients were included in this study, which 34 (55.70%) were male and 27 (44.30%) were female. The most common pathologic report was clear cell renal cell carcinoma followed by angiomyolipoma and papillary renal cell carcinoma. Forty-one patients underwent radical nephrectomy, of whom three, 25, and 10 patients had low, moderate, and high tumor complexity, respectively. Twenty patients underwent partial nephrectomy, of whom 10 patients had low tumor complexity and 10 patients had moderate tumor complexity. No patient had high tumor complexity. In the present study, the function coefficient showed that radius had the most influence on surgical decision-making, followed by nearness to collecting system, exophytic/endophytic, and location. We also developed the Ramathibodi equation to help selecting the proper operation. Conclusion: The R.E.N.A.L. nephrometry score is a feasible and standardized classification system for evaluating renal masses. It could be used to stratify tumor complexity and may help for surgical decision-making.