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Risk Factors for Perioperative Complications of Laparoscopic Adrenalectomy Including Single-Site Surgery

Hattori Seiya, Miyajima Akira, Maeda Takahiro, Hasegawa Masanori, Takeda Toshikazu, Kosaka Takeo, Kikuchi Eiji, Nakagawa Ken, Shibata Hirotaka, Oya Mototsugu

JOURNAL OF ENDOUROLOGY 26 （ 11 ） 1463 - 1467 2012年11月

研究論文（学術雑誌）, 共著, ISSN 0892-7790

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Prognostic value of renin-angiotensin system blockade in non-muscle-invasive bladder cancer

Yuge Kazuyuki, Miyajima Akira, Tanaka Nobuyuki, Shirotake Suguru, Kosaka Takeo, Kikuchi Eiji, Oya Mototsugu

Annals of Surgical Oncology 19 （ 12 ） 3987 - 3993 2012年11月

ISSN 1068-9265

Background. To determine whether the administration of renin-angiotensin system (RAS) inhibitors, such as angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs), affect disease outcome in non-muscle-invasive bladder cancer (NMIBC). Methods. A total of 330 patients with initially diagnosed NMIBC were identified. We retrospectively investigated the clinical outcomes after transurethral resection of bladder tumor (TUR-BT) in patients who did or did not receive RAS inhibitors. The median follow-up period was 4.1 years. Results. A total of 128 patients (38.8 %) experienced subsequent tumor recurrence, and stage progression was observed in 17 patients (5.2 %) during follow-up. Fifty-one patients (15.5 %) had received ACEI or ARB administration at transurethral resection. Multivariate analysis demonstrated that tumor multiplicity, absence of bacillus Calmette-Guérin instillation, and no administration of ACEI or ARB (P = 0.010, hazard ratio 2.26) were independent risk factors for subsequent tumor recurrence. The 5-year recurrence-free survival rate was 78.4 % in patients administered ACEIs or ARBs, and 53.3 % in their counterparts (P = 0.011). Conclusions. The absence of RAS inhibitor administration was an independent risk factor for subsequent tumor recurrence in patients with initially diagnosed NMIBC. Our data support further investigation of the role of RAS inhibitors as a potential therapy to decrease tumor recurrence in NMIBC.

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Prostate brachytherapy seed migration to a left varicocele

Sugawara Akitomo, Nakashima Jun, Kunieda Etsuo, Nagata Hirohiko, Mizuno Ryuichi, Seki Satoshi, Shiraishi Yutaka, Kouta Ryuichi, Oya Mototsugu, Shigematsu Naoyuki

Brachytherapy 11 （ 6 ） 502 - 506 2012年11月

ISSN 1538-4721

Purpose: To report a rare case of seed migration to a left varicocele after transperineal interstitial prostate brachytherapy with loose iodine-125 (¹²⁵I) seeds. Methods and Materials: A 73-year-old man presented with a serum prostate-specific antigen level of 5.21ng/mL, Gleason score of 7 (3+4), and clinical T1c adenocarcinoma of the prostate. The patient underwent transperineal interstitial prostate brachytherapy with loose ¹²⁵I seeds followed by external beam radiation therapy. Two weeks after seed implantation, a followup pelvic radiograph was obtained. One month after seed implantation, a pelvic computed tomography scan for postimplant dosimetric analysis was carried out. Subsequent ultrasound examination of the scrotum was undertaken. Results: Two weeks after seed implantation, an anteroposterior pelvic radiograph showed that a migrated seed was overlapped by the scrotum. Postimplant pelvic computed tomography revealed that a seed had migrated to the left side of the scrotum. Subsequent ultrasound examination of the scrotum revealed that the patient had a left varicocele to which the seed had migrated. The patient had no symptoms related to the migrated seed. Conclusions: This is the first report of seed migration to a left varicocele after transperineal interstitial prostate brachytherapy with loose ¹²⁵I seeds. For the present case, we suggest that the seed moved from the prostate to the left varicocele through the pelvic veins, bypassing the systemic circulation.

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Optimal ratio of transcription factors for somatic cell reprogramming

Nagamatsu Go, Saito Shigeru, Kosaka Takeo, Takubo Keiyo, Kinoshita Taisuke, Oya Mototsugu, Horimoto Katsuhisa, Suda Toshio

Journal of Biological Chemistry 287 （ 43 ） 36273 - 36282 2012年10月

ISSN 0021-9258

Somatic cell reprogramming is achieved by four reprogramming transcription factors (RTFs), Oct3/4, Sox2, Klf4, and c-Myc. However, in addition to the induction of pluripotent cells, these RTFs also generate pseudo-pluripotent cells, which do not show Nanog promoter activity. Therefore, it should be possible to fine-tune the RTFs to produce only fully pluripotent cells. For this study, a tagging system was developed to sort induced pluripotent stem (iPS) cells according to the expression levels of each of the four RTFs. Using this system, the most effective ratio (Oct3/4-high, Sox2-low, Klf4-high, c-Myc-high) of the RTFs was 88 times more efficient at producing iPS cells than the worst effective ratio (Oct3/4-low, Sox2-high, Klf4-low, c-Myclow). Among the various RTF combinations, Oct3/4-high and Sox2-low produced the most efficient results. To investigate the molecular basis, microarray analysis was performed on iPS cells generated under high (Oct3/4-high and Sox2-low) and low (Oct3/4-low and Sox2-high) efficiency reprogramming conditions. Pathway analysis revealed that the G protein-coupled receptor (GPCR) pathway was up-regulated significantly under the high efficiency condition and treatment with the chemokine, C-C motif ligand 2, a member of the GPCR family, enhanced somatic cell reprogramming 12.3 times. Furthermore, data from the analysis of the signature gene expression profiles of mouse embryonic fibroblasts at 2 days after RTF infection revealed that the genetic modifier, Whsc1l1 (variant 1), also improved the efficiency of somatic cell reprogramming. Finally, comparison of the overall gene expression profiles between the high and low efficiency conditions will provide novel insights into mechanisms underlying somatic cell reprogramming.

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Metastatic urothelial carcinoma to pericardia manifested by dyspnea from cardiac tamponade during systemic chemotherapy

Hattori Seiya, Miyajima Akira, Maeda Takahiro, Takeda Toshikazu, Morita Shinya, Kosaka Takeo, Kikuchi Eiji, Oya Mototsugu

Journal of the Canadian Urological Association 6 （ 5 ） 2012年10月

ISSN 1911-6470

A 53-year-old man presented for further evaluation due to microscopic hematuria and left lumbar pain. Computed tomography revealed a large tumour in the left renal pelvis with multiple metastases. Despite effective systemic chemotherapy, he developed dyspnea, and was diagnosed with cardiac tamponade. Pericardial involvement in an advanced malignancy is common, but symptomatic cardiac metastasis from urothelial carcinoma is rare. Of the reports of symptomatic cardiac metastasis from urothelial carcinoma, only 3 cases presented as cardiac tamponade. We report here a rare case of cardiac tamponade caused by a renal pelvic carcinoma with positive cytodiagnosis of pericardial effusion. We also summarize and discuss the symptoms, treatment, and prognosis of the pathological condition, and present a brief review of previously published reports.

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Optimal Ratio of Transcription Factors for Somatic Cell Reprogramming

Nagamatsu Go, Saito Shigeru, Kosaka Takeo, Takubo Keiyo, Kinoshita Taisuke, Oya Mototsugu, Horimoto Katsuhisa, Suda Toshio

JOURNAL OF BIOLOGICAL CHEMISTRY 287 （ 43 ） 36273 - 36282 2012年10月

研究論文（学術雑誌）, 共著, ISSN 0021-9258

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Diagnosis of acute bacterial prostatitis

Yazawa Satoshi, Kanao Kento, Hongo Hiroshi, Oya Mototsugu

Japanese Journal of Clinical Urology 66 （ 11 ） 817 - 822 2012年10月

ISSN 0385-2393

Does pelvic lymph node dissection improve the biochemical relapse-free survival in low-risk prostate cancer patients treated by laparoscopic radical prostatectomy?

Daimon Tatsuaki, Miyajima Akira, Maeda Takahiro, Hattori Seiya, Yasumizu Yota, Hasegawa Masanori, Kosaka Takeo, Kikuchi Eiji, Nakagawa Ken, Oya Mototsugu

Journal of Endourology 26 （ 9 ） 1199 - 1202 2012年09月

ISSN 0892-7790

Background and Purpose: The roles and criteria for pelvic lymph node dissection (PLND) are not fully evaluated in patients with low-risk prostate cancer who are treated by laparoscopic radical prostatectomy (LRP). In this study, the outcome of PLND was assessed in terms of the biochemical relapse-free survival rates of low-risk prostate cancer patients who had undergone LRP. Patients and Methods: Included were 286 consecutive patients who were treated with LRP without previous endocrine therapy between 2002 and 2006 at our institution. Failure rates for LRP were compared in 139 patients with low-risk prostate cancer between those who underwent PLND (n=85) and those who did not (n=54). Biochemical relapse-free survival for each group was estimated by Kaplan-Meier analysis. Results: The mean number of retrieved lymph nodes was 5.4±0.4 (range 2-22). The 5- and 7-year biochemical relapse-free survival rates were 90.1% and 88.3% in patients with PLND, and 82.4% and 82.4% in those without PLND (P=0.278), respectively (median follow-up 69.4 mos). None of the 85 patients undergoing PLND had positive lymph nodes. Only one patient had symptomatic lymphocele, and he was treated as an inpatient. The average time needed for PLND was 16 minutes, which corresponded to 7% of the entire operative time. Conclusion: These results indicate that the dissection of pelvic lymph nodes is not related to biochemical relapse-free survival. The omission of PLND in patients with low-risk prostate cancer not only does not adversely affect biochemical relapse-free survival, but might decrease the incidence of complication and operative time of LRP.

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Prognostic significance of high nuclear grade in patients with pathologic t1a renal cell carcinoma

Suzuki Kenjiro, Mizuno Ryuichi, Mikami Shuji, Tanaka Nobuyuki, Kanao Kent, Kikuchi Eiji, Miyajima Akira, Nakagawa Ken, Oya Mototsugu

Japanese Journal of Clinical Oncology 42 （ 9 ） 831 - 835 2012年09月

ISSN 0368-2811

Objective: A reliable prognostic indicator in patients with pathologic T1a renal cell carcinoma has not yet been fully elucidated. The aim of this study was to investigate the prognosis of pathologic T1a renal cell carcinoma cases with a special focus on pathological factors. Methods: The study population consisted of 338 patients diagnosed with solitary renal cell carcinoma at our hospital between 1996 and 2009. The relationship between disease progression and clinicopathologic features was analyzed retrospectively to determine if it affected recurrence and distant metastasis. Results: The Fuhrman nuclear grade distribution between the tumors was 1, 2, 3 and 4 in 68 (20.1%), 242 (71.6%), 21 (6.2%) and 7 cases (2.1%), respectively. A total of 11 subjects were identified as having recurrent tumors (3.3%), 9 of whom had metastatic lesions. Multivariate analysis showed that the appearance of tumor Grade 3 and 4 (hazard ratio: 13.0, 95% confidence interval: 3.90-43.0, P < 0.001) was an independent risk factor for tumor recurrence, while no significant correlation was found between tumor recurrence and age, gender, tumor side, tumor size, surgical methods, histology, microvascular invasion or surgical margin status. The 5-year recurrence-free survival rate was 67.8% in patients with a high nuclear grade tumor, and 96.8% in their counterparts. Conclusions: High nuclear grade is possibly one of the most important prognostic factors for predicting tumor recurrence and metastasis after surgery in pathologic T1a renal cell carcinoma. Thus, careful follow-up may be required in patients with pathologic T1a renal cell carcinoma of a high nuclear grade.

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Prognostic significance of Bacillus Calmette-Guerin failure classification in non-muscle-invasive bladder cancer

Shirakawa Hiroshi, Kikuchi Eiji, Tanaka Nobuyuki, Matsumoto Kazuhiro, Miyajima Akira, Nakamura So, Oya Mototsugu

BJU INTERNATIONAL 110 （ 6B ） E216 - E221 2012年09月

研究論文（学術雑誌）, 共著, ISSN 1464-4096

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Prognostic significance of 5-fluorouracil metabolism-relating enzymes and enhanced chemosensitivity to 5-fluorouracil by 5-chloro 2,4-dihydroxy-pyridine in urothelial carcinoma

Ide Hiroki, Kikuchi Eiji, Hasegawa Masanori, Kozakai Norihide, Kosaka Takeo, Miyajima Akira, Oya Mototsugu

BMC CANCER 12 E732 - E732 2012年09月

研究論文（学術雑誌）, 共著, ISSN 1471-2407

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Prognostic Significance of High Nuclear Grade in Patients with Pathologic T1a Renal Cell Carcinoma

Suzuki Kenjiro, Mizuno Ryuichi, Mikami Shuji, Tanaka Nobuyuki, Kanao Kent, Kikuchi Eiji, Miyajima Akira, Nakagawa Ken, Oya Mototsugu

JAPANESE JOURNAL OF CLINICAL ONCOLOGY 42 （ 9 ） 831 - 835 2012年09月

研究論文（学術雑誌）, 共著, ISSN 0368-2811

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Prognostic significance of Bacillus Calmette-Guérin failure classification in non-muscle-invasive bladder cancer

Shirakawa Hiroshi, Kikuchi Eiji, Tanaka Nobuyuki, Matsumoto Kazuhiro, Miyajima Akira, Nakamura So, Oya Mototsugu

BJU International 110 （ 6B ） 2012年09月

ISSN 1464-4096

Objective To investigate the differences in the clinical features and subsequent stage progression and disease-specific survival among patients with Bacillus Calmette-Guérin (BCG) failure, after dividing these patients into BCG-refractory, -resistant, -relapsing, and -intolerant groups. Patients and Methods We identified 173 patients with initial BCG failure from 521 patients who had undergone induction BCG therapy for non-muscle-invasive bladder cancer, excluding CIS, between 1987 and 2009. Patients were stratified into four BCG-failure groups, and each prognostic outcome was evaluated. Results Median follow-up period from initial BCG failure was 4.7 years. A total of 42 patients (24.3%) were stratified into the BCG-refractory, three (1.7%) into the BCG-resistant, 106 (61.3%) into the BCG-relapsing, and 22 (12.7%) into the BCG-intolerant group. Twenty-four patients (13.9%) experienced stage progression during follow-up. Multivariate analysis showed that pathological G3 at BCG failure (P= 0.014; risk ratio 2.84) and BCG-refractory (P < 0.001; risk ratio 4.68) were independent predictors for stage progression. The 10-year progression-free survival rates were 53.2%, 91.1% and 93.8% in the BCG-refractory, BCG-relapsing and BCG-intolerant groups, respectively. The stage progression rate was higher in the BCG-refractory than in the BCG-relapsing (P < 0.001) and BCG-intolerant (P= 0.007) groups. Similarly, the 10-year disease-specific survival rate in the BCG-refractory group was significantly worse than those in the other BCG failure groups (P < 0.001). Conclusions Stratification of BCG failure into the above-mentioned four groups can identify patients with BCG-failure in terms of their prognosis. The potential risk for critical adverse events was higher in the BCG-refractory group than in the other BCG-failure groups, despite the fact that patients in each group all underwent induction BCG therapy, therefore, treatment decisions, protocols and recommendations should be established based on each individual BCG-failure pattern.

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Predicting pubic arch interference in prostate brachytherapy on transrectal ultrasonography-computed tomography fusion images.

Fukada Junichi, Shigematsu Naoyuki, Nakashima Jun, Ohashi Toshio, Kawaguchi Osamu, Oya Mototsugu

Journal of Radiation Research 53 （ 5 ） 753 - 759 2012年09月

ISSN 0449-3060

We investigated the usefulness of the fusion image created by transrectal ultrasonography (TRUS) and large-bore computed tomography (CT) for predicting pubic arch interference (PAI) during prostate seed brachytherapy. The TRUS volume study was performed in 21 patients, followed by large-bore computed tomography of patients in the lithotomy position. Then, we created TRUS-CT fusion images using a radiation planning treatment system. TRUS images in which the prostate outline was the largest were overlaid on CT images with the narrowest pubic arch. PAI was estimated in the right and left arch separately and classified to three grades: no PAI, PAI positive within 5 mm and PAI of >5 mm. If the estimated PAI was more than 5 mm on at least one side of the arch, we judged there to be a significant PAI. Brachytherapy was performed in 18 patients who were evaluated as not having significant PAI on TRUS. Intra-operative PAI was observed in one case, which was also detected with a fusion image. On the other hand, intra-operative PAI was not observed in one case that had been evaluated as having significant PAI with a fusion image. In the remaining three patients, TRUS suggested the presence of significant PAI, which was also confirmed by a fusion image. Intra-operative PAI could be predicted by TRUS-CT fusion imaging, even when it was undetectable by TRUS. Although improvement of the reproducibility of the patients' position to avoid false-positive cases is warranted, TRUS-CT fusion imaging has the possibility that the uncertainty of TRUS can be supplemented.

Preimplant factors affecting prostate D90 after transperineal interstitial prostate brachytherapy with loose ¹²⁵I seeds

Sugawara Akitomo, Nakashima Jun, Kunieda Etsuo, Nagata Hirohiko, Mizuno Ryuichi, Takeda Atsuya, Seki Satoshi, Shiraishi Yutaka, Kouta Ryuichi, Oya Mototsugu, Shigematsu Naoyuki

Keio Journal of Medicine 61 （ 3 ） 89 - 94 2012年09月

ISSN 0022-9717

The dose received by 90% of the prostate volume (D90) is the key parameter of dosimetric analysis in prostate brachytherapy. The aim of this analysis was to identify preimplant factors affecting prostate D90 after transperineal interstitial prostate brachytherapy with loose ¹²⁵I seeds. We reviewed the records of 210 patients who underwent transperineal interstitial prostate brachytherapy with loose ¹²⁵I seeds for clinical T1/T2 prostate cancer at our institution. Patients who received supplemental external-beam radiation therapy were excluded. One hundred and nine patients (51.9%) received neoadjuvant hormonal therapy (NHT). One month after seed implantation, postimplant computed tomography and dosimetric analysis were performed. Univariate and multivariate analyses were carried out to identify preimplant factors affecting postimplant prostate D90. The postimplant prostate D90 values ranged from 123.3 to 234.1 Gy (mean ± standard error, 177.1 ± 1.4 Gy). Postimplant prostate D90 differed significantly between patients who had and had not undergone NHT (P = 0.001). In addition, simple regression analyses showed positive correlations with the estimated preimplant prostate D90, preimplant prostate volume by transrectal ultrasound (TRUS), total radioactivity, number of needles, and number of seeds. On stepwise multiple regression analysis, postimplant prostate D90 showed significant negative correlations with NHT and preimplant prostate volume by TRUS, and a significant positive correlation with total radioactivity. In conclusion, NHT, preimplant prostate volume by TRUS, and total radioactivity are significant preimplant factors affecting postimplant prostate D90 in prostate cancer patients treated with transperineal interstitial prostate brachytherapy with loose ¹²⁵I seeds.

Enhancement of radiosensitivity by a unique novel NF-B inhibitor, DHMEQ, in prostate cancer

Kozakai N., Kikuchi E., Hasegawa M., Suzuki E., Ide H., Miyajima A., Horiguchi Y., Nakashima J., Umezawa K., Shigematsu N., Oya M.

British Journal of Cancer 107 （ 4 ） 652 - 657 2012年08月

ISSN 0007-0920

Background: Inducible activation of nuclear factor (NF)-B is one of the principal mechanisms through which resistant prostate cancer cells are protected from radiotherapy. We hypothesised that inactivation of inducible NF-B with a novel NF-B inhibitor, DHMEQ, would increase the therapeutic effects of radiotherapy.Methods:PC-3 and LNCaP cells were exposed to irradiation and/or DHMEQ. Cell viability, cell cycle analysis, western blotting assay, and NF-B activity were measured. The antitumour effect of irradiation combined with DHMEQ in vivo was also assessed.Results:The combination of DHMEQ with irradiation resulted in cell growth inhibition and G2/M arrest relative to treatment with irradiation alone. Inducible NF-B activity by irradiation was inhibited by DHMEQ treatment. The expression of p53 and p21 in LNCaP, and of 14-3-3 in PC-3 cells, was increased in the combination treatment. In the in vivo study, 64 days after the start of treatment, tumour size was 85.1%, 77.1%, and 64.7% smaller in the combination treatment group than that of the untreated control, DHMEQ-treated alone, and irradiation alone groups, respectively.Conclusion:Blockade of NF-B activity induced by radiation with DHMEQ could overcome radio-resistant responses and may become a new therapeutic modality for treating prostate cancer.

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The prognostic significance of vasohibin-1 expression in patients with upper urinary tract urothelial carcinoma

Miyazaki Yasumasa, Kosaka Takeo, Mikami Shuji, Kikuchi Eiji, Tanaka Nobuyuki, Maeda Takahiro, Ishida Masaru, Miyajima Akira, Nakagawa Ken, Okada Yasunori, Sato Yasufumi, Oya Mototsugu

Clinical Cancer Research 18 （ 15 ） 4145 - 4153 2012年08月

ISSN 1078-0432

Purpose: Vasohibin-1 (VASH1) is a novel angiogenic molecule that is specifically expressed in activated vascular endothelial cells, and the status of VASH1 expression has been documented in cancer angiogenesis. The aim of this study was to address the prognostic value of VASH1 expression in upper urinary tract urothelial carcinomas (UTUC). Experimental Design: We retrospectively analyzed the clinical records of 171 patients with locally advanced UTUC (Ta-3N0M0). The median follow-up period was 3.8 years. We immunohistochemically examined the accomplished microvessels with anti-CD34 as microvessel density (MVD) and the microvessels with activated endothelial cells as VASH1 density. Then, we analyzed the association between immunohistochemical expression and clinical outcomes. Results: Forty-two patients experienced tumor recurrence and of these 34 died of the disease during follow-up. VASH1 density was significantly associated with tumor grade, pathologic T stage, and MVD. The 5-year recurrence-free and cancer-specific survival rates were 66.1% and 72.8% in patients with VASH1 density (≥ 40/mm²) and 81.0% and 86.5% in their counterparts, respectively (P < 0.05). MVD was not an independent predictor of tumor recurrence or cancer-specific survival. Multivariate analyses revealed that high VASH1 density was an independent prognostic indicator of both tumor recurrence (P = 0.024, HR = 2.10) and cancer-specific survival (P = 0.031, HR = 2.23) as well as other standard prognostic factors including high tumor grade and lymphovascular invasion. Conclusions: VASH1 density represents a clinically relevant predictor of patient prognosis in UTUC. The results suggest that VASH1 density could become a new biomarker and provide additional prognostic information in patients with UTUC.

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Renal cell carcinoma arising from a horseshoe kidney in a chronic hemodialysis patient

Miyazaki Yasumasa, Miyajima Akira, Maeda Takahiro, Ito Yujiro, Tanaka Nobuyuki, Kosaka Takeo, Masuda Aya, Mizuno Ryuichi, Kikuchi Eiji, Nakagawa Ken, Oya Mototsugu

Clinical and Experimental Nephrology 16 （ 4 ） 647 - 651 2012年08月

ISSN 1342-1751

A 60-year-old man undergoing hemodialysis for 13 years was referred to our department for evaluation of gross hematuria and a right renal mass. Voided urine cytology was negative. Computed tomography and magnetic resonance imaging demonstrated a right renal mass (32 × 22 × 20 mm in diameter). We clinically diagnosed the tumor as renal cell carcinoma staged T1aN0M0 arising from a horseshoe kidney, and performed right heminephrectomy. Pathological examination of the surgical specimen showed a grade 2, pT1a, clear cell carcinoma and negative surgical margin. To our knowledge, this is a rare case of a renal cell carcinoma arising from a horseshoe kidney in a chronic hemodialysis patient.

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Two cases of bowel perforation associated with sunitinib treatment for renal cell carcinoma

Hoshino Yoshinori, Hasegawa Hirotoshi, Ishii Yoshiyuki, Endo Takashi, Ochiai Hiroki, Okabayashi Koji, Kaneko Gou, Mikami Shuji, Mukai Makio, Oya Mototsugu, Kitagawa Yuko

INTERNATIONAL JOURNAL OF CLINICAL ONCOLOGY 17 （ 4 ） 412 - 416 2012年08月

研究論文（学術雑誌）, 共著, ISSN 1341-9625

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Transumbilical laparoendoscopic single-site varicocelectomy

Takeda Toshikazu, Miyajima Akira, Tanaka Nobuyuki, Kikuchi Eiji, Oya Mototsugu

Japanese Journal of Clinical Urology 66 （ 9 ） 675 - 678 2012年08月

ISSN 0385-2393

We performed transumbilical laparoendoscopioc singlesite varicocelectomy (LESS-V) for three patients with left painful varicocele. Their average age was 34.7 years old (23-46 years old) and their varicocele grades were grade III in all cases. The operation was performed by the same laparoscopic surgeon. The average operative time was 65 minutes (49-96 minutes) and the estimated blood loss was little. Postoperative pain was tolerant and analgesics was not used in all cases. There were no remarkable complications and the patients were discharged 2 or 3 days after surgery. All cases had complete resolution of pain within 5 months (2-5 months) and hydrocele, testicular atrophy, or recurrence was not seen. LESS-V is safe and feasible for laparoscopic surgeons.

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