Araştırma Çıktıları

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    Distal ureterectomy techniques in laparoscopic and robot-assisted nephroureterectomy: Updated review
    (WOLTERS KLUWER MEDKNOW PUBLICATIONS, 2015-01-01) Stravodimos, Konstantinos G.; Komninos, Christos; Kural, Ali Riza; Constantinides, Constantinos
    Controversies exist about the best method for managing the distal ureter during the laparoscopic (LNU) and robot-assisted nephroureterectomy (RANU). Therefore, PubMed, Scopus and Web of Science databases were searched in order to identify articles describing the management of distal ureter during LNU or RANU in patients suffering from upper urinary tract urothelial cell carcinoma. Forty seven articles were selected for their relevance to the subject of this review. The approaches that are usually performed regarding the distal ureter management are open excision, transurethral resection of ureteral orifice (Pluck Technique), ureteric intussusception and pure LNU or pure RANU. Pure LNU and RANU with complete laparoscopic dissection and suture reconstruction of ureter and bladder cuff seems to be better tolerated than open nephroureterectomy providing equal efficacy, without deteriorating the oncological outcome, however evidence is poor. Transurethral resection of the ureteric orifice and the bladder cuff after occlusion of the ureter with a balloon catheter seems to be an attractive alternative option for low stage, low grade tumors of the renal pelvis and the proximal ureter, while stapling technique is correlated with the increased risk of positive surgical margins. The open resection of the distal ureter in continuity with the bladder cuff is considered the most reliable approach, preferred in our practice as well, however the existing data are based on retrospective and non-randomized studies.
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    The Comparison of Conventional and Retzius-Sparing Robot-Assisted Radical Prostatectomy for Clinical, Pathological, and Oncological Outcomes
    (GALENOS YAYINCILIK, 2022-01-01) Karsiyakali, Nejdet; Ozgen, Mahir Bulent; Ozveren, Bora; Durak, Haydar; Saglican, Yesim; Turkeri, Levent
    Objective: This study aimed to assess and compare the conventional and Retzius-sparing robot-assisted radical prostatectomy (cRARP and RsRARP) in term of perioperative clinical, pathological, and oncological outcomes. Materials and Methods: This study included 238 consecutive male patients who underwent RARP between May 2008 and November 2020. RARP operations were performed by a single-surgeon. Patients were divided into groups according to the surgical approach and were statistically compared in terms of perioperative clinical, final pathological, and oncological outcomes. Results: The mean age of patients was 64 +/- 7 years. cRARP was performed in 134 (56.3\%) patients, whereas RsRARP in 104 (43.7\%). The frequency of patients with the American Society of Anesthesiologists Class-2 score was higher in the RsRARP group (p<0.001). The median surgery duration was 300 (270-360) min. The median surgery duration was shorter in RsRARP group (290 vs. 330 minute) (p<0.001). No difference was found between the groups in terms of estimated blood loss and postoperative complication rates (p=0.112 and p=0.182, respectively). No difference was found between the groups when they were compared for surgical margin positivity (p=0.453). Although not statistically significant, the frequency of surgical margin positivity with pT3a/pT3b disease was higher in patients who underwent cRARP (p=0.412 and p=0.261, respectively). At a median follow-up of 13 (6-36) months, no difference was found between the groups in terms of biochemical recurrence at months-3,-6,-9,-12,-18,-24, and-30, respectively (p>0.05, for each). Conclusion: RsRARP allows a safe operation with a shorter surgical time and similar surgical margin positivity, oncological outcomes, and complication rates compared to cRARP.
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    Can We Accomplish Better Oncological Results with Robot-Assisted Radical Prostatectomy?
    (MARY ANN LIEBERT, INC, 2017-01-01) Kural, Ali Riza; Obek, Can; Doganca, Tunkut
    Surgical removal with radical prostatectomy has been a cornerstone for the treatment of prostate cancer and is associated with level 1 evidence for survival advantage compared with watchful waiting. Since the first structured robotic program was launched in 2000, robot-assisted radical prostatectomy (RARP) has had a rapid diffusion and surpassed its open radical prostatectomy (ORP) and laparoscopic radical prostatectomy (LRP) counterparts in the United States and is progressively expanding in other countries. Interestingly, this common acceptance of RARP was initially driven in the paucity of robust clinical evidence. There is still lack of level 1 evidence with prospective randomized trials on the oncologic outcomes of RARP. In that scenario, the clinician has to rely on retrospective data and systemic and meta-analyses. In comparison with ORP and LRP, RARP has proven to reach at least equivalent oncological outcomes. Lower rate of positive surgical margins may probably be achieved with RARP in pT2 patients. Although urologists were initially reluctant to embrace RARP in highrisk patients and lymph node yield was low, contemporary series have revealed that RARP and extended lymphadenectomy may be safely performed with obtaining similar (or better) nodal yields compared with ORP. Surgeon experience is universally of utmost importance in obtaining good outcomes. We will need to wait for long-term results of contemporary series to comprehend the impact of RARP on cancer-specific survival and overall survival. Using novel imaging before surgery and frozen section analysis during surgery may allow for superior oncological outcomes.