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Öğe 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, SelcukObjective: 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.Öğe A Delphi consensus to standardize the technique of anatomical endoscopic enucleation of prostate: a study by ESUT endoscopic enucleation of prostate study group(Springer, 2023) Tunc, Lutfi; Herrmann, Thomas; Guven, Selcuk; Scoffone, Cesare Marco; Bozzini, Giorgio; Yilmaz, Sercan; Romero-Otero, JavierPurposeOur objective was to establish a standardized technique for Anatomical Endoscopic Enucleation of Prostate (AEEP) utilizing a consensus statement to provide robust recommendations for urologists who are new to this procedure.MethodsThe participants were electronically sent a questionnaire in three consecutive rounds. In the second and third rounds, the anonymous aggregate results of the previous round were presented. Experts' feedback and comments were then incorporated to refine existing questions or to explore more controversial topics in greater depth.ResultsForty-one urologists participated in the first round. In the second round, all Round 1 participants received a 22-question survey, resulting in a consensus on 21 items. In the third round, 76% (19/25) of the second-round respondents also participated, reaching a consensus on 22 additional items. The panelists consensually agreed on detaching the urethral sphincter at the beginning of the enucleation and not at the end of the enucleation. To prevent incontinence, it was recommended that the apical mucosa be preserved through various approaches between 11 and 1 o'clock while gently disrupting the lateral lobes in their apical part, avoiding an excess energy delivery approximation to the apical mucosa.ConclusionTo optimize laser AEEP procedures, urologists must follow expert guidelines on equipment and surgical technique, including early apical release, using the 3-lobe technique for enucleation, preserving apical mucosa with appropriate approaches, gently disrupting lateral lobes at their apical regions, and avoiding excessive energy delivery near the apical mucosa. Following these recommendations can lead to improved outcomes and patient satisfaction.Öğe Determination of Face and Content Validity of Cadaveric Model for Holmium Anatomic Endoscopic Enucleation of the Prostate Training: An ESUT AEEP Group Study(Elsevier, 2021) Tunc, Lutfi; Bozzini, Giorgio; Scoffone, Cesare Marco; Guven, Selcuk; Hermann, Thomas; Porreca, Angelo; Misrai, VincentBackground: Bench and virtual reality nonbiological simulator models for anatomic endoscopic enucleation of the prostate (AEEP) surgery have been reported in the literature. These models are acceptable but have limited practical applications. Objective: To validate a fresh-frozen human cadaver model for holmium AEEP training and assess its content validity. Design, setting, and participants: Holmium AEEP operations on fresh-frozen cadavers performed by an experienced surgeon were recorded, and a video, including the main steps of the operation, was produced. Outcome measurements and statistical analysis: The video and an accompanying questionnaire were subsequently distributed electronically to ESUT AEEP study group experts and associates (N = 32) for assessment of the AEEP training model. A ten-point Likert global rating scale was used to measure the content validity. Results and limitations: A total of 26 answers were returned (81%). The experts agreed on the model's suitability for AEEP training (mean Likert score: 8). According to the responses, identifying anatomic structures and landmarks was the most valuable aspect of the model in terms of AEEP training (median Likert score: 9). Conversely, the experts found the model's ability, in terms of demonstrating laser and tissue reactions, to be weak (median Likert score: 6) Conclusions: Based on the content validity assessment, the fresh-frozen cadavertraining model for laser AEEP seems to be a promising model for demonstrating and learning the correct prostate enucleation technique. Patient summary: An increasing number of researchers have proposed that anatomic endoscopic enucleation of the prostate (AEEP) should replace transurethral resection of the prostate surgery and become the gold standard for treatment of bladder outlet obstruction due to benign prostatic hyperplasia. AEEP requires anatomic familiarity for enucleation, technical knowledge, and a solid training program before starting with the first cases. This is the first cadaver study to assess the content validity of a fresh-frozen human cadaver model for AEEP training. (C) 2021 The Authors. Published by Elsevier B.V. on behalf of European Association of Urology.Öğe Evaluation of Applied Laparoscopic Urology Course Using Validated Checklist(Soc Laparoendoscopic Surgeons, 2013) Tunc, Lutfi; Guven, Selcuk; Gurbuz, Cenk; Gozen, Ali Serdar; Tuncel, Altug; Saracoglu, Firat; Istanbulluoglu, OkanBackground and Objectives: The objectives of this study were to investigate the effectiveness of the applied laparoscopic urology course using a validated checklist and to determine any differences in laparoscopic skills achieved by the participants at the end of the course period based on whether they began their training in a dry or wet laboratory. Methods: To facilitate the mastering of challenging laparoscopic skills by urologists, a unique 3-day mini-training program was established at the Gulhane Military Academy of Medicine, Surgical Research Center, Ankara, Turkey. Only 30 trainees were accepted in each course, and they were divided into 3 subgroups. The primary outcome of the study was the changes in the performance and task accomplishment duration of the trainees at the beginning compared with the end of the course. The secondary outcome was any differences in the basic skills of the trainees based on whether they started their training in the dry or wet laboratory. Results: The overall laparoscopic skills, which were evaluated by use of a standardized laparoscopic suturing task score, significantly improved (18.8 to 26.0, P < .001), and the time needed for task accomplishment decreased throughout the course (9.5 minutes to 5.25 minutes, P = .002). With respect to the course design, laparoscopic skills scores and the times needed for task accomplishment showed no statistically significant changes at the end of the course despite the fact that the trainees had started their training at different stages. Conclusion: The applied short-term laparoscopy course was shown to be an effective format particularly for achieving laparoscopic skills in which suturing and knotting are essential. This is mainly achieved through close cooperation in dry and wet laboratories.
