Araştırma Çıktıları

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    The role of laparoscopic experience on the learning curve of HoLEP surgery: A questionnaire-based study
    (AVES, 2020-01-01) Gazel, Eymen; Kaya, Engin; Yalcin, Serdar; Tokas, Theodoros; Yilmaz, Sercan; Aybal, Halil Cagri; Aydogan, Tahsin Batuhan; Tunc, Lutfi
    Objective: Holmium laser enucleation of the prostate (HoLEP) is an established method for treating benign prostatic obstruction. Nonetheless, its steep learning curve limits its wide distribution. The purpose of the present study was to demonstrate the impact of laparoscopic experience on HoLEP learning curve by evaluating the association between learning curves of surgeons performing both laparoscopy and HOLEP surgery. Material and methods: A questionnaire was prepared to identify surgeon's experience on laparoscopy and HoLEP, as well as their learning curves. This questionnaire was then distributed via e-mail to 110 urologists who are actively involved in endourology/laparoscopy. Results: Of the 110 urologists, 80 (72.7\%) responded and completed the questionnaire. Of the 80 surgeons, 47 (58.8\%) reported that they had completed the HoLEP learning curve with <20 cases. Moreover, 33 (41.2\%) reported that they were able to complete the learning curve by performing >20 cases. Completion of the HoLEP learning curve in <20 cases was reached at 1.3\%, 13.8\%, and 43.8\% by beginner, moderate skilled, and experienced laparoscopists, respectively (p<0.001). Conclusion: Laparoscopic experience appears to be beneficial for surgeons while learning HoLEP. Highly experienced laparoscopic surgeons have a shorterHOLEP learning curve.
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    Laparoscopic endometrioma resection increases peri-implantation endometrial HOXA-10 and HOXA-11 mRNA expression
    (ELSEVIER SCIENCE INC, 2015-01-01) Celik, Onder; Unlu, Cihat; Otlu, Baris; Celik, Nilufer; Caliskan, Eray
    Objective: To determine whether laparoscopic endometrioma resection alters peri-implantation endometrial HOXA-10, HOXA-11, LIF, ITGB3 and ITGAV mRNA expression. Design: Case-control study. Setting: Medical school. Patient(s): Twenty infertile patients with uni-or bilateral endometrioma, five infertile patients having nonendometriotic benign ovarian cyst, and five fertile control subjects. Intervention(s): Mid-luteal-phase endometrial sampling was performed at the time of surgery. Second endometrial biopsies were obtained 3 months after laparoscopic endometrioma resection during the mid-luteal phase of the cycle. Main Outcome Measure(s): Endometrial HOXA-10, HOXA-11, LIF, ITGAV, and ITGB3 mRNA expressions were evaluated with the use of reverse-transcription polymerase chain reaction. Result(s): Significantly decreased endometrial ITGAV mRNA expression was noted in biopsies obtained from endometrioma and nonendometriotic cyst groups before surgery. Trends toward decreased endometrial HOXA-10, HOXA-11, LIF, and ITGB3 mRNA expressions were noted in the endometrioma and nonendometriotic cyst groups before surgery compared with the fertile subjects. However, the differences failed to show statistical significance. Compared with preoperative values, significantly increased HOXA-10 (12.1-fold change) and HOXA-11 (17.2-fold change) mRNA expressions were noted in endometrial biopsies obtained from subjects who were undergoing endometrioma surgery. Fold change in endometrial ITGAV mRNA after endometrioma surgery was found to be 30.1 and indicated a positive regulation. However, this fold increase was statistically insignificant. Expressions of these endometrial receptivity markers did not change significantly after surgical removal of nonendometriotic benign ovarian cysts. Conclusion(s): Laparoscopic endometrioma resection increases peri-implantation endometrial HOXA-10 and HOXA-11 mRNA expression, suggesting an improvement in endometrial receptivity. (C) 2015 by American Society for Reproductive Medicine.
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    Ovarian cystectomy in endometriomas: Combined approach
    (GALENOS YAYINCILIK, 2014-01-01) Unlu, Cihat; Yildirim, Gazi
    Endometrioma is one of the most frequent adnexal masses in the premenopausal population, but the recommended treatment is still a subject of debate. Medical therapy is inefficient and can not be recommended in the management of ovarian endometriomas. The general consensus is that ovarian endometriomas larger than 4 cm should be removed, both to reduce pain and to improve spontaneous conception rates. The removal of ovarian endometriomas can be difficult, as the capsule is often densely adherent. While the surgical treatment of choice is surgical laparoscopy, for conservative treatment, the preferred method is modified combined cystectomy. Cystectomy can be destructive for the ovary, whereas ablation may be incomplete, with a greater risk of recurrence. To the best of our knowledge, the modified combined technique seems to be more efficient in the treatment of endometriomas.
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    Sclerosing stromal tumor: a rare ovarian neoplasm
    (GALENOS PUBL HOUSE, 2022-01-01) Kadirogullari, Pinar; Seckin, Kerem Doga
    Sclerosing stromal tumor (SST) is an extremely rare and distinctive sex cord stromal tumor, which occurs predominantly in the second and third decades of life. SSTs make up 2-6\% of ovarian sex-cord stromal tumors. Due to the solid and distinct vascular structure of the tumor, it can be mistaken as a number of malignant ovarian tumors. As this specific neoplasm is very rare, it is not always possible to diagnose the tumor preoperatively with clinical and ultrasonographic findings. Furthermore, histopathological and immunohistochemical analysis does not always confirm the diagnosis. In this case report, clinical findings, histopathological features, and macroscopic appearance during laparoscopy of an SST are presented in a 20-year-old woman with pelvic pain. SST should be considered among the differential diagnosis of women with adnexal masses.
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    Fundus-first technique and partial cholecystectomy for difficult laparoscopic cholecystectomies
    (TURKISH ASSOC TRAUMA EMERGENCY SURGERY, 2018-01-01) Sormaz, Ismail Cem; Soytas, Yigit; Gok, Ali Fuat Kaan; Ozgur, Ilker; Avtan, Levent
    BACKGROUND: This study aims to evaluate the impact of conversion from retrograde dissection to fundus-first technique (FF) or laparoscopic partial cholecystectomy (LPC) on complication rates, operation time, and duration of hospitalization. METHODS: The medical records of 210 consecutive patients who underwent laparoscopic cholecystectomy between January 2010 and December 2014 were retrospectively evaluated. All laparoscopic cholecystectomies were initiated with retrograde dissection (RD). In cases of difficulty in dissection of critical view of safety, the operation strategy was first converted to FF and then to LPC when FF was considered insufficient for safe cholecystectomy. RESULTS: Of the 210 cases, LC was initiated and completed with RD in 197 cases. FF was implemented in 13 cases due to difficulties in dissection. In the FF group, laparoscopic total cholecystectomy was successfully accomplished in seven patients, and LPC was performed in the remaining six cases. Three postoperative complications occurred in the RD group and two in the LPC group. No major intraoperative complications or perioperative mortality occurred in any patients. CONCLUSION: In elective, noncomplicated cases, the safe posterior window (critical view of safety) principle should be implemented. However, in complicated cases where anatomic uncertainties are dominant, the performance of FF technique or LPC may decrease conversion rates to open surgery and contribute to accomplishing the laparoscopic intervention safely.
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    Laparoscopic Extraperitoneal Radical Prostatectomy
    (GALENOS YAYINCILIK, 2020-01-01) Tekin, Ali; Yuksel, Alpaslan; Taskiran, Arda Taskin; Senoglu, Yusuf; Kayikci, Muhammet Ali
    Radical prostatectomy (RP) involves removing the entire prostate with its capsule intact and the seminal vesicles (SV). In this video article, we summarized the extraperitoneal laparoscopic RP with pelvic lymph node dissection procedure along with a video presentation of a case. The patient is placed in a Trendelenburg position. Through a small transverse infraumblical incision, the anterior rectus aponeurosis is identified and incised. The extraperitoneal surgical field is developed bluntly by a balloon dilator, and a 10 mm trocar is placed for the camera. CO2 insufflation at a 12-15 mmHg pressure is established, and the remaining trocars are placed. The fatty tissue is swept laterally to create a wide operative field. The endopelvic fascia is incised on both sides. The levator ani muscle fibers are separated from the lateral surface of the prostate. Dorsal vascular complex (DVC) is ligated with 2 consecutive sutures. Identification of the bladder neck (BN) is critical for proper dissection between the prostate and the BN. BN is incised until the catheter is seen. The urethral catheter is removed and a Bougie dilator is inserted through the urethra to elevate the prostate. With posterior oblique dissection, the vasa deferentia are exposed and clip-ligated, and SVs are identified and freed. Then, lateral pedicles are ligated with hemoclips and divided. Lateral dissection proceeds with an anterolateral incision from the base to the prostatic apex. The neurovascular bundles lie posterolateral to the prostate. Apical dissection and division of the DVC and urethra is a critical step to ensure a safe surgical margin and good postoperative erectile function and continence. The urethra is divided with a small rim on the prostate. The gland is totally freed, put into an endobag, and extracted. The vesicourethral anastomosis is done using two 3-0 monocryl sutures in a running fashion, starting from the posterior in both direction and tied together at the 12 o'clock position, anteriorly.