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Shih-Chieh Chueh

Publications and source records attributed to Shih-Chieh Chueh.

At least 19 recordsLinked to original sources
PubMed2006

Investigation of anti-tumor mechanisms of K2154: characterization of tubulin isotypes, mitotic arrest and apoptotic machinery.

Microtubules are crucial targets for cancer chemotherapeutic drugs, and new microtubule-directed agents are of continued interest in drug development. A novel microtubule-directed agent, ethyl-2-[N-rho-chlorobenzyl-(2'-methoxy)]-anilino-4-oxo -4, 5-dihydro-furan-3-carboxylate, was identified. The compound, designated K2154, inhibited cell proliferation, with IC(50) values of 10.3, 15.3, 9.6, 11.2, 12.8 and 12.1 muM in prostate cancer PC-3, hepatocellular carcinoma Hep3B, non-small cell lung cancer A549, colorectal cancer HT29 and HCT116, and P-glycoprotein-rich breast cancer NCI/ADR-RES cells, respectively. Because NCI/ADR-RES cells were susceptible to inhibition by K2154, it indicated that this compound is a poor substrate for P-glycoprotein. In this study, PC-3 cells were used to identify the anticancer mechanisms of K2154. K2154 induced an arrest of the cell cycle at G2/M phase and a subsequent increase of hypodiploid phase in PC-3 cells, whereas it only induced a moderate level of G2/M arrest with little increase of hypodiploid phase in normal prostate cells. K2154 inhibited microtubule assembly in both in vitro turbidity assay and in vivo microtubule spin-down experiment. Immunochemical examination showed that K2154 caused formation of abnormal mitotic characteristics with bipolar spindles, particularly, in beta(II)- and beta(III)-tubulin staining. It also induced several pathways, including cyclin B1 up-regulation, dephosphorylation on Tyr(15) and phosphorylation on Thr(161) of Cdk1 and Cdc25C phosphorylation, and roscovitine (a Cdk1 inhibitor) significantly inhibited K2154-induced apoptosis, suggesting a pro-apoptotic role of Cdk1. Phosphorylation of Bcl-2 and Bcl-xL and cleavage of Mcl-1, together with activation of caspase-9 and -3, indicated that mitochondrial pathway played a central role in K2154-mediated apoptotic cell death. Additionally, AIF contributed to a late phase of K2154-induced apoptotic pathway. In conclusion, it is suggested that K2154 displays an anticancer activity through a target on microtubules and a subsequent signaling cascade on cell cycle regulation and apoptotic machinery.

ATP Binding Cassette Transporter, Subfamily B, Mem↗
PubMed2006

Ilimaquinone, a marine sponge metabolite, displays anticancer activity via GADD153-mediated pathway.

The marine organisms produce many metabolic substances with numerous pharmacological activities. It has been suggested that ilimaquinone, a metabolite of sea sponge, can induce vesiculation of the Golgi apparatus and display several biological activities, such as anti-human immunodeficiency virus, anti-inflammation as well as anti-microbial activities. In this study, the sulforhodamine B assays showed that ilimaquinone induced a concentration-dependent anti-proliferative effect in several types of cancer cell lines, including prostate cancer PC-3 and LNCaP, non-small cell lung cancer A549 and hepatocellular carcinoma Hep3B cells. The anticancer mechanism of ilimaquinone in the representative PC-3 cells was identified. Ilimaquinone induced a time-dependent increase of G(1) phase arrest and a subsequent increase of hypodiploid sub-G(1) phase (apoptosis) of the cell cycle. The arrest of the cell cycle was associated with a sustained high level of nuclear cyclin E but the absence of DNA synthesis by flow cytometric analysis, indicating an incomplete S phase. Although ilimaquinone-induced Golgi vesiculation, the data showed that the inhibition of cancer cell growth was not through the Golgi fragmentation. Several biological kinases and transcription factors were examined in this study. The data demonstrated that ilimaquinone did not activate extracellular signal-regulated kinase and phosphatidylinositol 3-kinase but induce the up-regulation and nuclear translocation of growth arrest and DNA damage inducible gene 153 (CHOP/GADD153). Furthermore, ilimaquinone-mediated anti-proliferative effect is significantly reduced in the antisense CHOP/GADD153-overexpressing cells. Ilimaquinone also inhibited DNA binding of NF-kappaB; however, this inhibitory effect could not explain ilimaquinone-induced anticancer effect. In summary, it is suggested that ilimaquinone induces the anti-proliferative effect through the G(1) arrest of the cell cycle and the up-regulation and nuclear translocation of CHOP/GADD153.

Active Transport, Cell Nucleus↗
PubMed2006

Laparoscopic partial adrenalectomy for aldosterone-producing adenomas with needlescopic instruments.

INTRODUCTION: Laparoscopic total adrenalectomy is the treatment of choice for aldosterone-producing adenomas (APAs). There have not been many reports of laparoscopic partial adrenalectomy, although this procedure offers benefits to patients with suspected bilateral APAs or an APA in a solitary adrenal gland. We describe the feasibility of a novel technique of laparoscopic partial adrenalectomy for APA solely using 2-mm working instruments and a 5 to 10-mm telescope. TECHNICAL CONSIDERATIONS: Six unilateral and two bilateral partial adrenalectomies were performed laparoscopically. Only one umbilical 12-mm port for the telescope and two (for left adenomas) or three (for right adenomas) subcostal 2-mm working ports were used. Hemostasis and transection of adrenal tissues were performed using a 2-mm mini-bipolar coagulator and 2-mm scissors. RESULTS: All laparoscopic operations were successfully performed using only 2-mm working instruments and a 5 or 10-mm 30 degree telescope with no intraoperative or postoperative complications. Blood loss was minimal, and the operative times were comparable to those of previous reports. All patients had low pain scores, required minimal amounts of narcotics postoperatively, and reported excellent cosmetic results for the wounds. The pathologic examinations confirmed complete excision of all adenomas with intact capsules. The plasma aldosterone concentrations and renin activities returned to normal ranges postoperatively in all patients. At a mean follow-up of 25 months (range 13 to 48), 7 (87.5%) were cured of their hypertension and 1 had the hypertensive medications significantly reduced. CONCLUSIONS: Laparoscopic partial adrenalectomy for APAs using 2-mm working instruments and a 5 to 10-mm telescope is a safe and effective treatment alternative.

Adenoma↗
PubMed2006

Laparoscopic partial cystectomy for a vesical leiomyoma.

A 47-year-old woman presented with gross hematuria and urinary frequency for 6 months. The tumor located at the dome of bladder was resected by transurethral resectoscope. The pathology revealed leiomyoma; however, her symptoms did not improve after the endoscopic procedure. We performed transurethral mucosal incision for circumscribing the margin of tumor and transperitoneoscopic partial cystectomy to treat the patient successfully.

Cystectomy↗
PubMed2006

Laparoscopic adrenalectomy for potentially malignant adrenal tumors greater than 5 centimeters.

PURPOSE: Laparoscopic adrenalectomy (LA) is controversial for large, potentially malignant tumors. We report a series of LA or hand-assisted LA for large (>5 cm) adrenal tumors. PATIENTS AND METHODS: Among 210 LAs performed in 6 yr, 39 patients had potentially malignant tumors greater than 5 cm in diameter. Their perioperative and follow-up data were retrospectively analyzed. RESULTS: All 39 patients had successful LAs without perioperative mortality, conversion to open surgery, or capsular disruption during dissection. The mean tumor size was 6.2 cm (range, 5-12 cm), operative time 207 min (115-315 min), and blood loss 75 ml (minimal-1400 ml). Complications included one intraoperative diaphragmatic perforation, three mild wound infections, and one pneumonia. Preoperatively there were 27 nonfunctioning tumors, seven pheochromocytomas, three cortisol-secreting tumors, and two virilizing tumors. Final pathology revealed eight malignant (four adrenocortical carcinomas and four metastatic carcinomas) and 31 benign tumors (14 cortical adenomas, eight pheochromocytomas, six myelolipomas, and three ganglioneuromas). Median follow-up was 39 months. Four patients (two adrenocortical carcinomas, one metastatic hepatoma, and one lymphoma) died 24, 10, 9, and 3 months after surgery, respectively. A hand-assisted device was used in 10 patients. Only the tumor size was larger and length of postoperative hospital stay longer for those in the hand-assisted group. CONCLUSIONS: LA is a reasonable option for selected large adrenal tumors when complete resection is technically feasible and there is no evidence of local invasion. Hand-assisted LA is a good alternative to open conversion if a difficult dissection is encountered intraoperatively.

Adenoma↗
PubMed2006

Alisol B acetate, a triterpene from Alismatis rhizoma, induces Bax nuclear translocation and apoptosis in human hormone-resistant prostate cancer PC-3 cells.

The anti-tumor potential of components from Chinese herbal medicines has been greatly concerned. Alisol B acetate, a triterpene from Alismatis rhizoma, induced apoptotic cell death in human hormone-resistant prostate cancer PC-3 cells in a time- and concentration-dependent manner. A good correlation between loss of mitochondrial membrane potential and apoptotic cell death was apparent indicating the participation of mitochondria-related mechanism. Alisol B acetate induced Bax up-regulation and nuclear translocation; it also induced the activation of initiator caspase-8 and caspase-9, and executor caspase-3, suggesting the involvement of both extrinsic and intrinsic apoptosis pathways. Taken together, it is suggested that alisol B acetate induces apoptosis in PC-3 cells via a mitochondria-mediated mechanism with activation of caspase-8, -9 and -3. Furthermore, the Bax activation and translocation from the cytosol to nucleus might be a crucial response to the apoptotic effect.

Alismataceae↗
PubMed2006

Primary primitive neuroectodermal tumor of the urinary tract.

Primary primitive neuroectodermal tumor (PNET) of the urinary tract is a rare disease with aggressive behavior and poor prognosis. We analyzed 851 cases of urinary tract malignancies in our hospital between 1984 and 2004. Only three (0.035%) cases with PNET of the urinary tract were identified. Presenting symptoms included flank pain and hematuria. The first case was a 44-year-old man with left renal PNET who underwent hand-assisted laparoscopic radical nephrectomy and adjuvant chemotherapy. There was no recurrent tumor at the 4-year follow-up. The second case was a 75-year-old woman with right renal PNET with inferior vena cava (IVC) thrombosis extending to the right atrium. The patient underwent right radical nephroureterectomy and IVC thrombectomy with cardiopulmonary bypass. She died of metastatic disease 7 months later. The third case was a 45-year-old man with left ureteral PNET. Left ureteral segmental resection and partial cystectomy were performed. Tumor recurrence was noted 7 years later. The patient died of disseminated disease 1 year after the discovery of recurrence. Urinary tract PNET appears to be an aggressive malignancy. Long-term survival is possible if complete resection is performed at an early stage.

Adult↗
PubMed2005

Induction of mitotic arrest and apoptosis in human prostate cancer pc-3 cells by evodiamine.

PURPOSE: Although evodiamine, an alkaloid isolated from Evodiae fructus, has been reported to exert anticancer activities, to our knowledge its target and mechanism of action have not yet been explored. We examined the anticancer activities and action mechanism of evodiamine. MATERIALS AND METHODS: Human prostate cancer PC-3 cells were used in this study. The cytotoxic effect and cell growth inhibition were examined using the MTT (3-(4,5-dimethylthiazol-2-yl)2,5-diphenyltetrazolium bromide) assay and sulforhodamine B assay, respectively. The apoptotic effect was determined using TUNEL assay and the progression of cells through the cell cycle and cell apoptosis were examined by FACScan flow cytometry (Becton Dickinson, Sunnyvale, California). In situ mitotic spindle detection and in vitro tubulin polymerization assay were performed by immunofluorescence staining for beta-tubulin and CytoDYNAMIX ScreenTM3 (CDS-03) kits (Cytoskeleton, Denver, Colorado). RESULTS: It was found that treatment of PC-3 cells with evodiamine decreased the cell number in a concentration and time dependent manner, and effectively inhibited PC-3 cell growth via the induction of cell cycle arrest at the G2/M phase and subsequent apoptosis. In an in situ assay we found that evodiamine inhibited microtubule spindle formation. In a cell-free assay system of tubulin polymerization evodiamine inhibited the polymerization of microtubules in a concentration dependent manner. CONCLUSIONS: These data suggest that evodiamine shows anticancer activity through inhibition of tubulin polymerization. This antitubulin activity might make evodiamine a potential anticancer drug.

Apoptosis↗
PubMed2005

Expanding the donor pool: use of renal transplants from non-heart-beating donors supported with extracorporeal membrane oxygenation.

In response to organ shortage, we used the renal grafts from non-heart-beating donors (NHBDs). Extracorporeal membrane oxygenation (ECMO) was used to maintain NHBDs before organ procurement. We compared the results of renal transplantation from different donors, including heart-beating donors (HBDs), living-related donors (LDs), and NHBDs supported with ECMO. From February 1998 to June 2003, we recruited 219 patients receiving renal transplantation at National Taiwan University Hospital. Among them, 31 received kidneys from NHBDs supported with ECMO, 120 from HBDs, and 68 from LDs. Multiple organ transplant recipients were not included in this study. We compared the graft survival, serum creatinine levels, and estimated glomerular filtration rates of the three groups. The rate of delayed graft function was higher in NHBD recipients (41.9%) than in HBD recipients (27.0%) and LD recipients (10.9%) (p = 0.003). In the NHBD group, the recipients of grafts with delayed function had significantly longer ECMO runs (63.1 +/- 3.0 min) than those without delayed function (53.7 +/- 2.5 min) (p = 0.024). Estimated glomerular filtration rate (p = 0.472) and mean serum creatinine level (p = 0.286) were not significantly different between the three groups using a longitudinal approach. The 5-yr graft survival rates for NHBD (88.4%, 95% CI: 0.680-0.962), HBD (83.2%, 95% CI: 0.728-0.899), and LD transplant recipients (89.3%, 95% CI: 0.619-0.974) were not significantly different (p = 0.239). The 5-yr patient survival rates for NHBD, HBD, and LD transplant recipients were 100, 93.0 (95% CI: 0.859-0.966) and 100% respectively. The long-term allograft survival and function of kidneys from NHBDs supported by ECMO, HBD, and LD did not differ significantly. Long ECMO running time tended to delay graft function.

Adult↗
PubMed2004

Modulation of anti-adhesion molecule MUC-1 is associated with arctiin-induced growth inhibition in PC-3 cells.

BACKGROUND: Lignans have been reported to possess anti-tumor activity in various cancer cells. However, their anticancer effects in human prostate cancer have not been well established. Here, we examine the effect of arctiin, a lignan compound, on growth regulation in prostate cancer PC-3 cells. We postulated that arctiin modulates the attachment/detachment of PC-3 cells and we investigated the role of arctiin on MUC-1 expression. METHODS: The effect of arctiin on PC-3 cell growth was examined using an MTT assay method and cell number was calculated by means of a standard regression line. The expressions of MUC-1 and integrins alpha2, alpha5, and beta1 were detected using FACScan flow cytometric analysis. Levels of MUC-1 mRNA were determined using reverse transcriptase PCR (RT-PCR). RESULTS: Treatment of PC-3 cells with arctiin decreased the cell number in a concentration- and time-dependent manner in serum-containing condition. Arctiin preferentially induced cell detachment, but did not have anti-proliferation or cytotoxic effects in PC-3 cells. The arctiin-induced effect was inhibited by cycloheximide, indicating that protein synthesis was required. FACScan flow cytometric analysis demonstrated that arctiin increased the expression of the anti-adhesion mucin MUC-1, but did not affect integrin expression in PC-3 cells. The arctiin-induced increase in MUC-1 protein expression was due to up-regulation of mRNA, as revealed by RT-PCR analysis. CONCLUSIONS: Arctiin significantly induces cell detachment and decreases the cell numbers via the up-regulation of MUC-1 mRNA and protein in PC-3 cells.

Cell Adhesion↗
PubMed2004

Investigation of ouabain-induced anticancer effect in human androgen-independent prostate cancer PC-3 cells.

To determine the therapeutic potential of cardiac glycosides in androgen-independent prostate cancer, we examined ouabain-induced cytotoxic effect as well as the signaling pathways in PC-3 cells. Ouabain induced a time- and concentration-dependent cytotoxicity using mitochondrial MTT reduction assays, and the effective threshold concentration was in nanomolar level. At the concentrations less than 10 nM, ouabain induced a decrease of mitochondrial activity until a 7-hr exposure was performed, while it induced a rapid drop of mitochondrial function as early as a 2-hr treatment of cells with high concentrations of ouabain suggesting the involvement of two distinct mechanisms to ouabain action. After functional examinations, the data showed that both low and high concentrations of ouabain induced an inhibition of Na+-K+ ATPase and a subsequent 45Ca2+ influx into PC-3 cells. High concentrations of ouabain induced a significant and time-dependent loss of mitochondrial membrane potential (Deltapsim), a sustained production of reactive oxygen species (ROS), and severe apoptotic reaction. Ouabain also induced an increase of Par-4 (prostate apoptosis response 4) expression. Furthermore, an antisense, but not nonsense, oligomer against Par-4 expression significantly inhibited the cytotoxicity induced by low concentrations of ouabain. It is suggested that ouabain induces two modes of cytotoxic effect in human hormone-independent prostate cancer PC-3 cells. Low concentrations of ouabain induce the increase of Par-4 expression and sensitize the cytotoxicity; while high concentrations of ouabain induce a loss of Deltapsim, a sustained ROS production and a severe apoptosis in PC-3 cells.

Androgens↗
PubMed2004

The trend of managing prostate cancer in Taiwan.

BACKGROUND: The purpose of this study is to investigate the current trends of Taiwanese urologists in managing prostate cancer (CaP). This will help us to establish our own consensus and recommend appropriate treatment options to the related patients. METHODS: From November 2000 to April 2001, a questionnaire concerning the alertness of detecting CaP, diagnostic tools used for establishing the staging of CaP before radical surgery, the tolerated age for surgery and the use of hormone therapy for advanced CaP was mailed to the 465 urologists in active practice in the Taiwan area. RESULTS: A total of 240 (51.6%) physicians responded to our questionnaire. 89.1% of the respondents would add serum prostatic-specific antigen (PSA) to detect suspected malignancy during the work-up for benign prostatic hyperplasia in their daily practice. About three quarters of the respondents adopted free/total PSA in assisting the decision for prostate biopsy. 78% require a bone scan before radical surgery even when PSA is less than 10 ng/mL and the age tolerated for radical surgery is 75 years. 60.8% still believed that maximal androgen blockade is effective for advanced CaP. CONCLUSIONS: The trend of treating CaP provides a useful insight into the variations in clinical practice of Taiwanese urologists and may help to develop a more widely accepted guideline by our urological community.

Humans↗
PubMed2003

Giant renal oncocytoma: differential diagnosis.

Differentiation between oncocytoma and renal cell carcinoma in preoperative imaging studies remains difficult. We report a huge renal oncocytoma in a 51-year-old male. Despite the characteristic features of this oncocytoma by imaging studies, including a well-defined margin and central stellate scar on computed tomography (CT), and spoke-wheel vascular distribution on angiography, a confident diagnosis of oncocytoma could not be made preoperatively.

Adenoma, Oxyphilic↗
PubMed2003

Effect of sirolimus in combination with low-dose cyclosporine and steroids on acute renal allograft rejection.

BACKGROUND AND PURPOSE: Sirolimus is a novel immunosuppressive drug with much less nephrotoxicity than cyclosporine. The efficacy and toxicity of the combination of sirolimus and low-dose cyclosporine therapy were compared with data from records of a previous cyclosporine-based regimen used in patients with renal allograft transplantation. PATIENTS AND METHODS: A prospective study was conducted to assess the clinical effects of a sirolimus (6 mg loading dose over 48 hours plus 2 mg/day maintenance)/cyclosporine (8 mg/kg/day) combination regimen. Three male and 9 female renal transplant recipients were enrolled in the study. The primary endpoint was the incidence of acute rejection. The efficacy and adverse effects of the combined therapy were compared with those recorded in medical records of 24 renal transplant recipients who had received a cyclosporine-based regimen (10 mg/kg/day). RESULTS: The 12-month acute rejection rate of the study group was 16.67% (2/12), and that of the cyclosporine-based group 29.16% (7/24). One patient in the study group died of complications sustained during a radical operation for recurrent bladder carcinoma during the sixth post-transplant month. The 12-month graft and patient survival rates of the study group were both 91.8%. In the 12 months post-transplant, the mean serum creatinine levels of the study group were significantly lower than those of the historic group at months 1, 3, and 4. The average cyclosporine trough levels of the study group were significantly lower than those of the historic group at months 1, 2, and 12. The average daily doses of prednisolone in the study group were also lower than those of the historic group at months 2, 3, 4, and 12. CONCLUSIONS: The sirolimus/cyclosporine combination regimen reduced the incidence of acute renal allograft rejection, did not affect renal function, and reduced the dosage of cyclosporine and steroids compared with the cyclosporine regimen.

Acute Disease↗
PubMed2002

Handport-assisted laparoscopic living-donor nephrectomy; initial experience in Taiwan.

The feasibility of handport-assisted laparoscopic living-donor nephrectomy in Taiwan was assessed by comparison with conventional open nephrectomy. Six serial patients undergoing laparoscopic living-donor nephrectomy (LLDN) were compared with six patients undergoing open donor nephrectomy. Body-mass index (BMI), operating time, hospital stay, and short-term graft function were assessed in both groups of patients. Handport-assisted LLDN was successfully attempted in all six patients. Mean ischemic time was 4.5 min in the laparoscopic group. There was no major complication in either group. Short-term graft function was good in all patients, except for one case of chronic rejection with mild azotemia in the open group. The length of stay was significantly longer in the open group, but the operation time of the laparoscopic group was much longer than that of the open group. There was no difference in the resumption of diet and in the use of narcotic analgesics in addition to patient-controlled analgesia. LLDN is a technically demanding approach. With handport assistance, the surgeons could shorten their learning curve. While initial graft function rates are equal to those of the open method, cosmesis and hospital stay are improved by the laparoscopic approach. Longer follow-up and larger patient numbers are needed to confirm these initial results in Taiwan.

Adult↗
PubMed2002

Characterization of some novel alpha 1-adrenoceptor antagonists in human hyperplastic prostate.

We synthesized some quinazoline-based compounds, such as FH-71 (ethyl 4-(3-(4-(2-methoxyphenyl)piperazinyl)aminoquinazolin-2-carboxylate), EW-65 (4-(3-(4-(2-methoxyphenyl)piperazinyl)propyl)aminoquinazolin-2-carboxamide) and EW-154 (2-(4-(4-(2-methoxyphenyl)piperazinyl)butyl)amino-4-cyclohexylamino-quinazolin), and then characterized their pharmacological properties in several tissues. All of these compounds produced potent inhibition of phenylephrine but not high K(+) or U46619 (11 alpha,9 alpha-epoxymethano-15S-hydroxy-prosta-5Z,13E-dienoic acid)-induced contractions in rat aorta, suggesting alpha(1)-adrenoceptor antagonist properties. With rat vasa deferentia and spleens as the functional alpha(1A)- and alpha(1B)-adrenoceptor models, respectively, FH-71 exhibited greater antagonistic potency in rat vas deferens, EW-154 in rat spleen, and EW-65 had similar effects in both tissues. The potency ratios of terazosin, FH-71, EW-65 and EW-154 against phenylephrine-induced contractions in rat vas deferens/spleen were 1, 19.04, 0.39 and 0.09, respectively. The results suggest that FH-71 is a selective alpha(1A)-adrenoceptor antagonist, whereas EW-154 exhibits more antagonistic selectivity against alpha(1B)-adrenoceptors. FH-71 also showed a greater potency than EW-65 and EW-154 against phenylephrine-induced contraction in human hyperplastic prostate. The pA(2) values were 8.34, 7.44 and 7.05, respectively. Furthermore, FH-71 and EW-65 were not cytotoxic whereas EW-154 (all in 10 microM) had a massive toxic effect (more than 80%) in human prostatic smooth muscle cells. These data show FH-71 to be a potent and selective alpha(1A)-adrenoceptor antagonist with activity in human hyperplastic prostate.

Adrenergic alpha-1 Receptor Antagonists↗
PubMed2002

Clipless laparoscopic adrenalectomy with needlescopic instruments.

PURPOSE: We describe our experience with clipless laparoscopic adrenalectomy using needlescopic instruments. We compared the results with those of a contemporary series of conventional laparoscopic adrenalectomy. MATERIALS AND METHODS: In 12 patients clipless laparoscopic adrenalectomy was performed with needlescopic instruments in an 8-month period. The technique included 2 or 3 subcostal 2 mm. ports and 1 umbilical 5/12 mm. port for the telescope and ultimate specimen extraction. Adrenal vessels were controlled by bipolar coagulation without endoscopic clips. Outcome data were retrospectively compared with those on 20 recent conventional laparoscopic adrenalectomies done at the same institution. The 2 types of laparoscopic adrenalectomy were performed transperitoneally. RESULTS: Patients in the clipless group had a lower mean analgesic requirement (7.5 versus 15.3 mg. morphine sulfate equivalent, p = 0.02), lower mean pain and scar scores (3.1 versus 5.3 and 1.1 versus 4.2, respectively, p <0.05) and more rapid convalescence (1.6 versus 3.3 weeks, p <0.01) but longer operative time (183 versus 136 minutes, p = 0.04). Similar blood loss, time to oral intake and hospital stay were noted in the 2 groups. No major complications, open conversions or postoperative secondary bleeding occurred in either group. A 2 mm. port was converted to a 10 mm. port in only 1 case in the clipless group due to the inability to retract a bulky liver properly with a needlescopic instrument. CONCLUSIONS: Clipless laparoscopic adrenalectomy with needlescopic instruments is feasible for most benign adrenal tumors. In addition to the benefits of conventional laparoscopic surgery, clipless needlescopic laparoscopic adrenalectomy further decreased postoperative pain, shortened convalescence and improved wound cosmesis.

Adrenal Gland Neoplasms↗