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Permanent URI for this collectionhttps://hdl.handle.net/11443/932
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Item Impact of Refractive Errors on Da Vinci SI Robotic System(SOC LAPAROENDOSCOPIC SURGEONS, 2020-01-01) Tuna, Mustafa Bilal; Kilavuzoglu, Ayse Ebru; Mourmouris, Panogiotis; Argun, Omer Burak; Doganca, Tunkut; Obek, Can; Ozisik, Ozan; Kural, Ali RizaObjective: To investigate the impact of refractive errors on binocular visual acuity while using the Da Vinci SI robotic system console. Methods: Eighty volunteers were examined on the Da Vinci SI robotic system console by using a near vision chart. Refractive errors, anisometropia status, and Fly Stereo Acuity Test scores were recorded. Spherical equivalent (SE) were calculated for all volunteers' right and left eyes. Visual acuity was assessed by the logarithm of the minimal angle of resolution (LogMAR) method. Binocular uncorrected and best corrected (with proper contact lens or glasses) LogMAR values of the subjects were recorded. The difference between these values (DiffLogMAR) are affected by different refractive errors. Results: In the myopia and/or astigmatism group, uncorrected SE was found to have significant impact on the DiffLogMAR (P < 0.001) and myopia greater than 1.75 diopter had significantly higher DiffLogMAR values (p < 0.05). Subjects with presbyopia had significantly higher DiffLogMAR values (p < 0.01), and we observed positive correlation between presbyopia and DiffLogMAR values (p = 0.33, p < 0.01). The cut off value of presbyopia that correlated the most with DiffLogMAR differences was found to be 1.25 diopter (P< 0.001). In 13 hypermetropic volunteers, we found significant correlation between hypermetropia value and DiffLogMAR (p > 0.7, p < 0.01). The statistical analysis between Fly test and SE revealed a significant impact of presbyopia and hypermetropia to the stereotactic view of the subject (p = -0.734, p < 0.05). Conclusion: Surgeons suffering from myopia greater than 1.75 diopter, presbyopia greater than 1.25 diopter (D), and hypermetropia regardless of grade must always perform robotic surgeries with the proper correction.Item Water Vapor Thermal Therapy (RezumTM) for Benign Prostate Hyperplasia: Initial Experience from Turkiye(GALENOS PUBL HOUSE, 2022-01-01) Tuna, Mustafa Bilal; Doganca, Tunkut; Argun, Omer Burak; Pirdal, Betul Zehra; Tufek, Ilter; Obek, Can; Kural, Ali RizaObjective: Rezumn{''} system is a safe minimal invasive treatment modality for benign prostate hyperplasia (BPH) treatment. The aim of this study was to evaluate the short-term results of Rezumn{''} therapy in our center.Materials and Methods: We retrospectively collected the data of 28 patients with symptomatic BPH who underwent RezumTM therapy in our center. All patients' pre-operative and post-operativeItem Is robotic radical nephroureterectomy a safe alternative to open approach: The first prospective analysis(PAGEPRESS PUBL, 2021-01-01) Mourmouris, Panagiotis; Argun, Omer Burak; Tzelves, Lazaros; Tuna, Mustafa Bilal; Gourtzelidou, Maria; Tziotis, Andreas; Kural, Ali Riza; Skolarikos, AndreasPurpose: To test the efficacy and safety profile of robotic radical nephroureterectomy compared to the open approach. Methods: We enrolled 45 consecutive patients who suffered from non-metastatic, upper urinary tract urothelial carcinoma from September 2019 to March 2021 and underwent radical nephroureterectomy. Patients were divided in two groups: group A consisted of 29 patients (open approach) and group B consisted of 16 patients (robotic approach). The factors which were taken into consideration were age, sex, body mass index, tumour size, side and grade, cancer stage, ASA score, operation time, drain removal time, foley time, hospitalization time, estimated blood loss, surgical margins, preoperative and postoperative creatinine, Hct and bladder recurrences. Statistical analysis was performed with the use of SPSS version 26 and p < 0.05 was the cut-off for reaching statistical significance. Results: The mean age in group 1 was 67.12 years and in group 2 68.12 years, whereas the mean body mass index (BMI) in group 1 was 26.54 kg/m(2) and in group 2 25.20 kg/m(2). Operative time was better in group A (124 vs 186 mins p < 0.001) and estimated blood loss were better in group B compared to group A (137 vs 316 ml p < 0.001). Length of stay (LOS) was significantly less in the robotic group (5.75 vs 4.3 days p = 0.003) and the same applied for time required for drain removal (4.5 vs 33 days p = 0.006). Conclusions: Robotic radical nephroureterectomy is a safe and efficient alternative to open approach. It provides a favorable perioperative profile in patients suffering from upper urinary tract carcinoma without metastasis.Item Minimizing Ports During Robotic Partial Nephrectomy(SOC LAPAROENDOSCOPIC SURGEONS, 2016-01-01) Argun, Omer Burak; Mourmouris, Panagiotis; Tufek, Ilter; Obek, Can; Tuna, Mustafa Bilal; Keskin, Selcuk; Kural, Ali RizaBackground and Objective: Robotic upper urinary tract surgery is in most of the cases performed utilizing a standard 5 port configuration. Fewer ports can potentially produce a less invasive operation. Taking in consideration the above we report a novel technique for robot assisted laparoscopic partial nephrectomy utilizing fewer ports and we test its feasibility and safety profile. Methods: Data on 11 robot-assisted laparoscopic partial nephrectomies performed by using our technique from February 2015 through June 2015 were retrospectively analyzed. The robotic platform used was DaVinci Xi (Intuitive Surgical, Inc., Sunnyvale, California, USA) with a 3-arm setup. The AirSeal system (SurgiQuest, Milford, Connecticut, USA) was used as a port allowing simultaneous introduction of 2 instruments for the bedside surgeon, obviating the need for an additional (fourth) robotic arm. A long suction-and-irrigation device and atraumatic grasping forceps were used. Both instruments were introduced through the trocar of the AirSeal system, making simultaneous introduction and use possible. We preferred the long suction-and-irrigation device, because it minimizes collision of the instruments. Results: Mean age and BMI of the patients were 55 +/- 14.6 y and 29.18 +/- 6.85, respectively. Seven tumors were on the right side and 4 were on the left. The mean size of the tumors was 32.45 mm (+/- 11.31). Surgical time was 132.2 minutes (+/- 37.17), with an estimated blood loss and ischemia time of 103.63 mL (+/- 65.92) and 16.72 minutes (+/- 9.52), respectively. One patient had postoperative bleeding that was resolved without transfusion. The median hospitalization period was 3.9 d (+/- 0.53). Loss of intra-abdominal pressure was not observed, and pressure was stable at 10 mm Hg. Conclusion: The AirSeal System and its valveless trocar eliminated the need for an additional port placement in our series. The technique is feasible, safe, and reproducibleItem Dose routine intraoperative Double J stent insertion avoid urine leakage after open partial nephrectomy?(PAGEPRESS PUBL, 2022-01-01) Bosnali, Efe; Dillioglugil, Ozdal; Teke, Kerem; Yilmaz, Hasan; Bayrak, Busra Yaprak; Uslubas, Ali Kemal; Avci, Ibrahim Erkut; Argun, Omer Burak; Kara, OnderObjective: To evaluate the impact of Double stent (DJS) insertion during open partial nephrectomy (OPN) on postoperative prolonged urinary leakage. Materials and methods: A retrospective study was made in consecutive cases of OPN performed between 2002 and 2020 for localized kidney tumors at our tertiary center. Urinary leakage was defined as drainage > 72 hours after surgery by biochemical analysis consistent with urine or radiographic evidence of urine leakage. The patients were divided into two groups according to intraoperative DJS placement, and compared regarding clinicopathologic characteristics, perioperative and postoperative outcomes. Univariate and multivariate logistic regression analyses were performed to determine the factors associated with urinary leakage after the operation. Results: Review of records identified 182 patients who were included in the study. In 73 (40\%) patients PN was performed without insertion of a DJS. Thus, 109 (60\%) of patients had a DJS inserted. Apart from higher preoperative eGFR values among patients with DJS (96.6 vs. 94.3 mL/min/1.73 m(2)Item Magnetic Resonance - Transrectal Ultrasound Fusion Guided Prostate Biopsy(GALENOS YAYINCILIK, 2016-01-01) Argun, Omer Burak; Obek, Can; Kural, Ali RizaProstate has remained as the single solid organ for which biopsy cannot be performed from a lesion for decades. Lately, the groundbreaking magnetic resonance imaging (MRI) techniques have emerged to scan prostate cancer and have become an important diagnostic tool in the diagnosis of prostate cancer. Efforts to improve the accuracy of the standard biopsy methods have led to the emergence of target-oriented biopsy methods. Today, MRI-transrectal ultrasound (TRUS) fusion guided biopsy methods are being used increasingly, especially for patients with an increasing prostate specific antigen level after a previous negative biopsy result and for patients under follow-up with active surveillance protocols. Even though it is not yet suggested in guidelines, our view and practice are in line with the fact that MRI-TRUS fusion guided biopsy is the most ideal biopsy method in any patient scheduled for a prostate biopsy with a significant lesion on MRI.Item Management of prostate cancer patients during COVID-19 pandemic(SPRINGERNATURE, 2020-01-01) Obek, Can; Doganca, Tunkut; Argun, Omer Burak; Kural, Ali RizaProstate cancer patients' management demands prioritization, adjustments, and a tailored approach during the unprecedented SARS-CoV-2 pandemic. Benefit of care from treatment must be carefully weighed against the potential of infection and morbidity from COVID-19. Furthermore, urologists need to be cognizant of their obligation for wise consumption of restricted healthcare resources and protection of the safety of their coworkers. Nonurgent in-person clinic visits should be postponed or conducted remotely via phone or teleconference. Prostate cancer screening, imaging, and biopsies may be suspended in general. Treatment may be safely deferred in low and intermediate risk patients. Surgery may be delayed in most high-risk patients and neoadjuvant ADT is generally not advocated prior to surgery. Initiation of long-term ADT coupled with EBRT subsequent to the pandemic may be favored as a feasible alternative in high-risk and very high-risk disease. In patients with cN1 disease, treatment within 6 weeks is advocated. Presurgery assessment should include testing for COVID-19 and preferably a chest imaging. In the presence of SARS-CoV-2 infection, surgery should be postponed whenever possible. All protective measurements suggested by national/international authorities must to be diligently followed during perioperative period. Strict precautions specific to laparoscopic/robotic surgery are required, considering the unproven but potential risk of aerosolization of SARS-CoV-2 virus and spillage with pneumoperitoneum. Regarding radiotherapy, shortest safe EBRT regimen should be favored and prophylactic whole pelvic RT and brachytherapy avoided. Chemotherapy should be avoided whenever possible.