Selçuk Altın, Ramazan Topaktaş, Ali Akkoç, Cemil Aydın, Reha Girgin, Zeynep Aydın, Kadir Yıldırım

Laparoskopik Ürolojik Cerrahi Başlangıç Deneyimlerimiz

Amaç: Kliniğimizde gerçekleştirilen ürolojik laparoskopik cerrahi olguların sonuçları ve komplikasyonlarını geriye dönük olarak değerlendirmek.Yöntemler: Ocak 2012 - Ocak 2015 tarihleri arasında laparoskopik operasyon geçiren toplam 115 hasta geriye dönük incelendi. Hastaların demografik özellikleri, preoperatif tanıları, laparoskopik yaklaşım şekli, ameliyat ve yatış süreleri, cerrahi işlem esnasında ve sonrasında gelişen komplikasyonlar ve açık cerrahiye geçilen hastalar açısından incelendi.Bulgular: Hastaların 61’i kadın, 54’ü erkek ve ortalama yaşları 52,4±11,7 yıl idi. Altmış sekiz olguda transperitoneal, 47 olguda ise retroperitoneal girişim uygulandı. Toplam 29 hastaya basit böbrek kisti eksizyonu, 25 hastaya basit nefrektomi, 22 hastaya üreterolitotomi, 19 hastaya radikal nefrektomi, 15 hastaya piyelolitotomi ve 5 hastaya da piyeloplasti yapıldı. Toplam 115 vakanın 4’ünde (%3,4) açık operasyona geçildi. Bu hastalar dışında majör komplikasyon ve mortalite görülmedi. En sık yapılan ameliyatların ortalama süreleri ise; böbrek kist eksizyonu 62 dk, basit nefrektomi 125 dk, üreterolitotomi 108 dk, radikal nefrektomi 141 dk, piyelolitotomi 116 dk ve pyeloplasti 166 (150190) dk idi. Ortalama yatış süresi 3,7±2,8 gün idi. Sonuç: Uyguladığımız laparoskopik cerrahilerin sonuçları, başarı ve komplikasyon oranları literatürle uyumlu bulundu. Laparoskopik cerrahi, teknolojinin gelişmesi, deneyimlerin artmasıyla ayrıca hastalar tarafından daha iyi tolere edilmesi nedeniyle açık cerrahiye alternatif, güvenli ve minimal invaziv bir tedavi yöntemi olduğunu düşünmekteyiz

Anahtar Kelimeler:

Laparoskopi, başlangıç deneyimleri, retrospektif

Our Initial Experiences with Laparoscopic Urologic Surgery

Objective: Retrospectively, to evaluate outcomes and complications of urological laparoscopic surgery cases performed in our clinic.Methods: A total of 115 patients who received laparoscopic surgery between January 2012 and January 2015 were retrospectively evaluated. Included patients were assessed in terms of demographic characteristics, preoperative diagnosis, type of laparoscopic approach, duration of surgery and hospitalization, complications before and after surgery, and postoperative requirement for open surgery.Results: 61 of included patients were women, 54 were male, and the mean age was 52.4±11.7 years. Sixty-eight patients underwent transperitoneal and 47 patients received retroperitoneal procedures. While 29 patients received renal cyst excision, 25 had simple nephrectomy, 22 had ureterolithotomy, 19 had radical nephrectomy, 15 had pyelolithotomy and 5 had pyeloplasty. Four (3,4%) of the 115 patients required converting to open surgery. Except these patients, no major complication or mortality was encountered. The mean duration of surgery for the most commonly applied procedures were as follows: renal cyst excision 62 (50-110) min, simple nephrectomy 125 (95-140) min, ureterolithotomy 108 (90-130) min, radical nephrectomy 141 (105-175) min, pyelolithotomy 116 (95-140) min, and pyeloplasty 166 (150-190) min. The mean hospital stay was 3.7±2.8 (2-11) days.Conclusion: The success and complication rates of the laparoscopic surgeries performed in our clinic were consistent with those reported in the literature. In the light of technological advances and increasing experience, as well as based on the higher tolerance exhibited by patients, we believe that laparoscopic surgery is a minimally invasive method that is a safe alternative to open surgery.Key words: Laparoscopy, initial experiences, retrospective

Keywords:

-,

PDF

___

Demir Ö, Öztürk B, Eğriboyun S, Esen AA. Initial experience with urologic laparoscopic surgery in our clinic and the learning process. Dokuz Eylül Üniversitesi Tıp Fakültesi Derg 2010;24:105-112.
Schuessler WW, Vancaillie TG, Reich H, Griffith DP. Transperitoneal
endosurgical lymphadenectomy in patients with localized prostate cancer. J Urol 1991;145:988-991.
Clayman RV, Kavoussi LR, Soper NJ, et al. Laparoscopic nephrectomy: initial case report. J Urol 1991;146:278-282.
Chung JH, Lee SW, Lee KSet al. Safety of en bloc ligation of the renal hilum during laparoscopic radical nephrectomy for renal cell carcinoma: a randomized controlled trial. J Laparoendosc Adv Surg Tech A 2013;23:489-494.
Rassweiler J. Laparoscopic radical prostatectomy is also oncologically safe and effective! BJU Int 2013;112:158.
Leclair MD, Vidal I, Suply E, et al. Retroperitoneal laparoscopic heminephrectomy in duplex kidney in infants and children: a 15 -year experience. Eur Urol 2009;56:385-389.
Kim C, McKay K, Docimo S. Laparoscopic nephrectomy in children: systemic review of transperitoneal laparoscopic and retroperitoneal approaches. Urology 2009;73:280-284.
Dağgulli M, Utanğaç MM, Bozkurt Y, et al. Our laparoscopic radical nephrectomy experiences. Dicle Med J 2014;41:732-737.
Keeley FX, Tolley DA. A review of our first 100 cases of laparoscopic nephrectomy: Defining risk factors for complications. Br J Urol 1998;82:615-618.
Siqueira TM, Kuo RL, Gardner TA, et al. Major complications in 213 laparoscopic nephrectomy cases: The Indianopolis experience. J Urol 2002;168:1361-1365.
Rassweiler JJ, Seemann O, Henkel T, et al. Retroperitoneoscopy.
Technique and experiences with the first 100 patients. Urol A 1996; 35: 185-195.
Kural AR, Demirkesen O, Akpınar H, et al. Our initial experiences with laparoscopic nephrectomy. Turk J Urol 2004;30:414-421.
Hatipoğlu NK, Penbegül N, Söylemez H, et al. Urological laparoscopic surgery: Our experience of first 100 cases in Dicle University. J Clin Exp Invest 2012;3:44-48.
Bayraktar AM, Ölçücüoğlu E, Taştemur S, et al. Initial results of our laparoscopic urological surgery: Firs 32. Fırat Medical Journal 2014;19:75-78.
Wickham JEA. The surgical treatment of renal lithiasis. In: Urinary Calculous Disease. edn. Edited by JEA W: New York, NY: Churchill-Livingstone; 1979: 145-198.
Gaur DD, Trivedi S, Prabhudesai MR, et al. Laparoscopic ureterolithotomy: technical considerations and long-term follow-up. BJU Int 2002;89:339-343.
Simforoosh N, Bassiri A, Danesh A, et al. Laparoscopic management of upper urinary tract stones: a report of 134 cases. Urology 2006;68:15.
Nambirajan T, Jeschke S, Albqami N, et al. Role of laparoscopy in management of renal stones: single-center experience and review of literature. J Endourol 2005;19:353-359.
Türk C, Knoll T, Petric A, et al. Guidelines on urolithiasis. European Association of Urology, Guidelines 2015.
Patloo AM, Sarmast AH, Khan MA, et al. Laparoscopic retroperitoneal pyelolithotomy and open pyelolithotomy: a comparative study. Turk J Urol 2012;38:195-200.
Schuessler WW, Grune MT, Tecuanhuey LV, Preminger GM. Laparoscopic dismembered pyeloplasty. J Urol 1993;150:1795-1799.
Eden CG. Minimally invasive treatment of ureteropelvic junction obstruction: a critical analysis of results. Eur Urol. 2007;52:983-989.
Tan BJ, Rastinehad AR, Marcovich R, et al. Trends in rtereropelvic
junction obstruction management among urologists in the United States. Urology 2005;65:260-264.
Soulie M, Seguin P. Urological complications of laparoscopic surgery: Experience with 350 procedures at a single center. J Urol 2002;165:1960-1963.
Rassweiler JJ, Teber D, Frede T. Complications of laparoscopic
pyeloplasty. World J Urol 2008;26:539-547.