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    Comparison of Laparoscopic Vessel Sealing Devices in a Porcine Model: Turkurolap Group Study
    (Kuwait Medical Assoc, 2013) Arslan, Murat; Akin, Yigit; Ates, Mutlu; Gozen, Ali Serdar; Tunc, Lutfi; Guven, Selcuk
    Objective: To compare the effectiveness of different electrosurgical devices used during laparoscopic surgery in Turkey Design: Retrospective study Setting: Gulhane Military Medical Academy, Experimental laboratory, Turkey Subject and Methods: Six large White-Landrace-Pietrain pigs, with a mean weight of 63 +/- 3.61 kg, were used in 2011. Interventions: Laparoscopic Vessel Sealing Devices Main Outcome Measures: Sealing time, demarcation, destruction, sticking, and burning effects of laparoscopic electrosurgical devices were investigated in blood vessels and ureters Results: Sealing process was significantly shorter with LigaSure Atlas (LS-10 mm and LS-5 mm), Plasma Trissector Gyrus (PTG) and Harmonic Scalpel (HS) in gonadal vessels. The shortest superficial demarcation was provided with HS. The sticking effects of the LS-5 mm and PTG were lower in ureters. The superficial demarcation was shorter with PTG than LS-5 mm, LS-10 mm and HS in ureters. Conclusions: HS stands out a bit more among devices with electrosurgical effects and fewer side effects to surrounding tissues than other devices in our study. Electrosurgical device should be selected according to necessity of the kind of dissection.
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    The effect of peritoneal re-approximation on lymphocele formation in transperitoneal robot-assisted radical prostatectomy and extended pelvic lymphadenectomy
    (Aves, 2020) Boga, Mehmet Salih; Sonmez, Mehmet Giray; Karamik, Kaan; Yilmaz, Kayhan; Savas, Murat; Ates, Mutlu
    Objective: The objective of the study was to evaluate the effect of peritoneal re-approximation at the end of the procedure in transperitoneal robot-assisted radical prostatectomy (tRARP) and extended pelvic lymphadenectomy (ePLND) on operative, oncologic, and symptomatic lymphocele rates. Material and methods: A total of 79 patients were included in the study who underwent tRARP and bilateral ePLND performed by two different experienced surgeons. One of the surgeons performed the peritoneal re-approximation (Group 1, n=41) and the other did not re-approximate the peritoneum (Group 2, n=38) at the end of the procedure in tRARP and ePLND. Operative parameters and symptomatic lymphocele rates were compared between the groups. Results: There were no significant differences between the preoperative parameters age, body mass index, and preoperative prostate-specific antigen values (p>0.05). The perioperative parameters were as follows: the operation time and estimated blood loss (EBL) was less, and the number of removed lymph nodes was higher in Group 2. However, only the difference in the EBL was statistically significant (p=0.03). Hospitalization time, symptomatic lymphocele, intervention requiring lymphocele, and complication rates were found to be less in Group 2, but only hospitalization time was statistically significant (p=0.04). Pathological parameters were similar for both groups. There was a significant correlation between lymph node positivity and the presence of symptomatic lymphocele in the correlation analysis (p=0.05). Conclusion: It has been shown in this study that the re-approximation of the peritoneum does not provide any additional benefit in terms of complications. Considering that this process also increases the operation time and lymphocele formation, we think there is no need for re-approximation after robot-assisted radical prostatectomy and pelvic lymphadenectomy.
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    Long-term outcomes of minimally invasive surgeries in partial nephrectomy. Robot or laparoscopy?
    (Wiley, 2021) Boga, Mehmet Salih; Sonmez, Mehmet Giray; Karamik, Kaan; Ozsoy, Cagatay; Aydin, Arif; Savas, Murat; Ates, Mutlu
    Background To compare long-term oncological and renal functional outcomes of laparoscopic and robotic partial nephrectomy for small renal masses. Methods A total of 103 patients who underwent laparoscopic (n = 31) and robotic (n = 72) partial nephrectomy between April 2015 and November 2018 were included in the study. Perioperative parameters, long-term oncological and functional outcomes were compared between the laparoscopic and robotic groups. Results No significant differences were found in terms of age, tumour size, RENAL and PADUA scores, pre-operative estimated glomerular filtration rate (eGFR), and presence of chronic hypertension and diabetes (P = .479, P = .199, P = .120 and P = .073, P = .561, and P = .082 and P = .518, respectively). Only estimated blood loss was significantly higher in the laparoscopic group in operative parameters (158.23 +/- 72.24 mL vs. 121.11 +/- 72.17 mL; P = .019), but transfusion rates were similar between the groups (P = .33). In the laparoscopic group, two patients (6.5%) required conversion to open, while no conversion was needed in the robotic group (P = .89). There were no differences in terms of positive surgical margin and complication rates (P = .636 and P = .829, respectively). No significant differences were observed in eGFR changes and post-operative new-onset chronic kidney disease at 1 year after the surgery (P = .768, P = .614, respectively). The overall mean follow-up period was 36.07 +/- 13.56 months (P = .007). During the follow-up period, no cancer-related death observed in both group and non-cancer-specific survival was 93.5% and 94.4% in laparoscopic and robotic groups, respectively (P = .859). Conclusions In this study, perioperative and long-term oncological and functional outcomes seems to be comparable between laparoscopic and robotic partial nephrectomies.
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    Single-center experience of robot-assisted radical cystectomy (RARC) and extended pelvic lymph node dissection
    (Aves, 2020) Boga, Mehmet Salih; Ozsoy, Cagatay; Aktas, Yasin; Aydin, Arif; Savas, Murat; Ates, Mutlu
    Objective: To report the outcomes of robot-assisted radical cystectomy (RARC) and extended pelvic lymph node dissection (ePLND) series for bladder cancer. Material and methods: Between October 2016 and June 2019, overall 57 patients (50 men, 7 women) were included in the study. Patient demographics, operative data, and postoperative pathological outcomes were evaluated. Patients who had a history of pelvic or intraabdominal surgery due to other concurrent malignancy, radiation therapy, or lacked data were excluded from the study. Results: The mean age of the patients was 64.72 +/- 9.09 years. The mean operation time, intraoperative estimated blood loss, and hospitalization time were 418.58 +/- 85.66 minutes, 313.00 +/- 79.16mL, and 13.44 +/- 5.25 days, respectively. The postoperative pathological stages were reported as pT0 (n=8), pTis (n=4), pT1 (n=4), pT2 (n=22), pT3a (n=11), pT3b (n=2), pT4a (n=4), pT4b (n=1), and other (n=1). The mean lymph node (LN) yield was 23.45 +/- 943. Positive LNs were found in 16 (28.1%) patients. Surgical margins were positive in 3 (5.26%) patients. The mean follow-up period was 15.42 +/- 8.31 months. According to the modified Clavien-Dindo system, minor (Clavien 1-2) and major (Clavien 3-5) complications occurred in 18 (31.58%) and 9 (15.78%) patients during the early (0-30 days) period and in 4 (7.02%) and 5 (8.77%) patients in the late (31-90 days) period. Conclusion: RARC and ePLND are complex but safe procedures with acceptable morbidity and excellent surgical and oncologic outcomes in muscle-invasive or high-risk bladder tumors.