Two trocar laparoscopic varicocelectomy: approach and outcomes.

BACKGROUND AND OBJECTIVES: The surgical indications and proper management of varicoceles in the pediatric population continue to be controversial. Historically, open surgical approaches have had recurrence rates between 2% to 6% and a low rate of complications. We present a modified laparoscopic technique for the treatment of clinically significant varicoceles. METHODS: Consecutive pediatric patients presenting with clinically significant varicoceles between May 2000 and July 2003 were considered for laparoscopic varicocelectomy. A 5-mm 2-port laparoscopic varicocelectomy was performed, with supraumbilical and contralateral lower quadrant placement of the trocars. The Harmonic scalpel was used to fulgurate the spermatic vessels in a nonartery sparing technique. RESULTS: Ten clinically significant varicoceles were identified in 9 patients, all of which were ligated with this technique. One patient was treated for bilateral varicoceles. Average operating room time was 53 minutes (range, 45 to 65). All patients were discharged from the ambulatory surgery unit and returned to their regular physical activity within 2 weeks after surgery. Upon clinical reevaluation 6 weeks post surgery, there was no evidence of varicocele recurrence or hydrocele formation, and all patients were asymptomatic. CONCLUSIONS: Our 2-port laparoscopic varicocelectomy is comparable to traditional open surgical approaches in recurrence and complication rates. This laparoscopic repair may be superior to open techniques in operating time, convalescence, and cosmesis. The procedure is easily mastered and does not require microsurgical skills.

Screening and identification of differentially expressed transcripts in circulating cells of prostate cancer patients using suppression subtractive hybridization.

BACKGROUND: Tumor metastasis and changes in host immunosurveillance are important components in cancer development. Tumor cell invasion into the bloodstream is an essential step for systemic metastasis. Currently, the detection of tumor cells in the circulation is mainly dependent upon the utilization of known epithelial cell markers. However, expression of these molecules is not limited to cancer patients; healthy people also have a small number of epithelial cells in their circulation. Utilizing these markers to detect circulating tumor cells (CTCs) cannot adequately explain the mechanisms of tumor cell survival or their development of metastatic potential in peripheral blood. The immune system can also evolve along with the cancer, actually promoting or selecting the outgrowth of tumor variants. Unfortunately, both metastasis and immunosurveillance remain mysterious and are debatable because we have yet to define the molecules that participate in these processes. We are interested in identifying the existence of expressed genes, or mRNA species, that are specifically associated with circulating cells of cancer-bearing patients using prostate cancer (PCa) as a model. RESULTS: We established two comprehensive subtracted cDNA libraries using a molecular technique called suppression subtractive hybridization. This technique selectively amplifies transcripts that are specifically expressed in circulating cells of either PCa patients or healthy men. Following sequencing reaction, we showed that 17 out of 23 (73.9%) sequenced clones did not match any mRNAs in the GenBank database. This result suggests that genes associated with alterations in circulating cells of cancer-bearing patients are largely unknown. Semi-quantitative RT-PCR confirmed that two genes are up-regulated in circulating cells of PCa patients, whereas another two genes are down-regulated in the same patients. CONCLUSION: The comprehensive gene expression analysis is capable of identifying differentially expressed genes in circulating cells of healthy men and PCa patients. We did not attempt to enrich specific cell types in this study because phenotypes of CTCs and subsets of leukocytes participating in immunosurveillance remain largely unknown. Continuous studies of these differentially expressed genes will eventually lead us to understand the mechanisms involved in tumor metastasis and immune modulation during cancer development.