Browsing by Author "Terzi, Hasan"

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Evaluation of the surgical outcome and complications of total laparoscopic hysterectomy in patients with enlarged uteruses
(ELSEVIER SCIENCE BV, 2016-01-01) Terzi, Hasan; Hasdemir, Pinar Solmaz; Biler, Alper; Kale, Ahmet; Sendag, Fatih
Objective: The aim of this study was to investigate whether uterine weight has a deleterious effect on the operation time, complication rates, length of hospital stay and incidence of intraoperative haemorrhage during total laparoscopic hysterectomy operation. Methods: A total of 282 patients who underwent total laparoscopic hysterectomy for benign gynaecologic indications were retrospectively analyzed. The median operation time of 70 min was accepted as an index number, and a cut-off point of >= 300 g was calculated for uterine weight by using reciever operator characteristics (ROC) curve analysis. Results: There was no statistically significant relationship between the uterine weight and haemoglobin drop rate (1.27 +/- 0.89 vs 1.21 +/- 0.88, p = 0.905), complication rate (10.83\% vs 9.26\%, p = 0.062) and length of hospital stay (3.27 +/- 1.23 vs 3.37 +/- 1.35 days, p = 0.505) based on this cut. Lee-Huang point was preferred for abdominal entry in cases with uteruses reached the level of umbilicus -2 cm in physical examination. Conclusions: Uterine weight was not effected the complication rate, estimated blood loss and length of hospital stay in total laparoscopic hysterectomy operation. A cut-off value of 300 g could be used for an increased operation time. (C) 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.
Total laparoscopic hysterectomy: Analysis of the surgical learning curve in benign conditions
(ELSEVIER, 2016-01-01) Terzi, Hasan; Biler, Alper; Demirtas, Omer; Guler, Omer Tolga; Peker, Nuri; Kale, Ahmet
Objective: To assess the learning curve for total laparoscopic hysterectomy. Methods: This study was a retrospective analysis of the learning curve for two surgeons during their first 257 consecutive cases of total laparoscopic hysterectomy at a teaching hospital. Patients were divided sequentially into groups comprising the first 75 patients, the next 75, and the final 107 patients. Age, body mass index, gestational parity, indications for laparoscopic hysterectomy, previous pelvic surgery, operating time, haemoglobin decline, complications, need for transfusion, and length of hospital stay were evaluated. Results: The mean operating time for total laparoscopic hysterectomy reduced significantly from 76.2 min to 68.9 min (p = 0.001) between the first and second 75-patient groups. Linear regression analysis showed a plateau was reached on the learning curve after 71-80 cases. The rate of all complications started at 8\% in the first group of 75 patients, reduced to 6.7\% in the next group, and decreased further in the final group to 4.7\%. The decline was not statistically significant (p = 0.6). The difference in the need for transfusion was statistically significant between the first 75 patients and the second group of 75 (p = 0.04). Conversion from laparoscopy to laparotomy was required in five patients, four in the early group and one in the final group. Age, body mass index, parity, previous pelvic surgery, decline in haemoglobin, and length of hospital stay were similar among the three groups. Conclusions: A plateau in the learning curve for TLH was reached after the first 75 cases. We can infer that there is a learning curve for TLH as confirmed by the decrease in operating time (accompanied by no change in complications) correlated to gain in experience. On the other hand, one should not disregard the fact that laparoscopy is not a complication-free surgery and achievement of the learning curve does not exclude complications. Gynaecological surgeons can perform TLH securely during the learning curve. (C) 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.