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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.