Ömer DEMİR, Bilgin ÖZTÜRK, Sedat EĞRİBOYUN, AHMET ADİL ESEN

Kliniğimizde laparoskopik cerrahide ilk deneyimlerimiz ve öğrenme süreci

laparoskopik ameliyatların sonuçları ve komplikasyonları geriye dönük olarak değerlendirildi. Gereç ve yöntem: Kliniğimizde Ağustos 2009-Mart 2010 tarihleri arasında 32 hastaya (17 erkek, 15 kadın) laparoskopik ameliyat uygulandı. Ortalama yaşları 51,7 ± 14,3 (19- 72) yıl olan hastaların 15’i renal kitle, 5’i nonfonksiyone böbrek, 4’ü üreter taşı, 3’ü sürrenal kitle, 3’ü üreteropelvik bileşke darlığı, 2’si böbrek kisti nedeniyle ameliyat edildi. Laparoskopik girişimlerin 19’u transabdominal, 13’ü ise retroperitoneal yöntemle gerçekleştirildi. Her iki yöntemde de ortalama trokar yerleştirme süresi 16,6 ± 3,0 (15-25) dakikaydı. Bulgular: Transabdominal ve retroperitoneal tüm girişimlerin ortalama ameliyat süresi 173,3 ± 51,8 (90-300) dakikaydı. Perop ve postop dönemde ortalama 0,8 ± 1,5 (0-7) ünite eritrosit süspansiyonu kullanıldı. Hastalar ortalama 1,1 ± 0,3 (1-2) günde mobilize edildiler. Ameliyat sonrası dönemde ağrı kesici olarak 2,3 ± 0,6 (1-4) gün nonsteroid antiinflamatuar ilaç kullanıldı. Hastaların sondası ortalama 2,8 ± 2,8 (1-13) günde, dreni ise 4,9 ± 3,0 (2-14) günde çekildi. Hastanede ortalama kalış süresi 6,0 ± 3,1 (2-14) gündü. Dört (%12,5) hastada (3 renal kitle, 1 sürrenal kitle) renal ven yaralanmasına bağlı kanama nedeniyle açık operasyona geçildi. Bu hastalara perop dönemde 2 ünite eritrosit süspansiyonu verildi. Sonuç: Laparoskopi öğrenme eğrisi uzun olan cerrahi bir tekniktir. Transabdominal ve retroperitoneal laparoskopik girişimler düşük morbidite ve komplikasyon oranları, yüksek hasta memnuniyeti ve kısa hastanede kalış süresi ile tercih sebebidir. Bu minimal invaziv yöntemin sunduğu avantajlardan, değişik patolojileri olan hastalar yararlanabilmektedir.

Inıtıal experence wıth urologıc laparascopıc surgery ın our clınıc and the learnıng process

Objective: The results of the laparoscopic surgeries performed in our clinic between August 2009 and March 2010 and the complications that occurred due to these surgeries were evaluated retrospectively. Material and method: Thirty-two patients (17 men, 15 women) underwent laparoscopic surgery in our clinic. The mean age of the patients was 51.7 ± 14.3 (19-72) years and the indications for surgery were renal mass in 15 patients, non-functional kidney in 5 patients, ureter stone in 4 patients, adrenal mass in 3 patients, ureteropelvic junction obstruction in 3 patients and renal cyst in 2 patients. Of the 32 laparoscopic interventions, 19 were performed transabdominally and 13 were performed retroperitoneally. For both methods, the mean throcar placement duration was 16.6 ± 3.0 (15-25) minutes. Results: Mean duration of surgery was 173.3 ± 51.8 (90-300) minutes for the transabdominal and retroperitoneal interventions. An average of 0.8 ± 1.5 (0-7) units of erythrocyte suspension were used peroperatively and postoperatively. The patients were mobilized at 1.1 ± 0.3 (1-2) days. Nonsteroid anti-inflammatory drugs were administered as analgesics for 2.3 ± 0.6 (1-4) days, on average. The urethral catheters were removed after 2.8 ± 2.8 ( 1-13) days and the drainage tubes were removed after 4.9 ± 3.0 (2-14) days. Mean hospital stay was 6.0 ± 3.1 (2-14) days. Four patients (12.5%, 3 with renal mass and 1 with surrenal mass) were converted to open surgery due to renal vein injury. Peroperatively, 2 units of erythrocyte suspension were given to these patients. Conclusion: Laparoscopy is a surgical technique that requires a long learning curve. Transabdominal and retroperitoneal laparoscopic interventions are preferable since they are associated with low morbidity, low complication rates, high patient satisfaction and short hospital stay. Patients with various pathologies may benefit from the advantages offered by this minimal invasive method.

PDF

___

1. Griffith DO, Schussler WW, Vancaille TH. Laparoscopic lymphadenectomy: A low morbidi-ty alternative for staging pelvic malignancies. J. Endourol 1990;4: 84-86.
2. Clayman RV, Kavoussi LR, Soper NJ et al. Laparoscopic nephrectomy: Initial case report. J Urol 1991;146: 278- 282.
3. Ehrlich RM, Gershman A, Mee S et al. Laparoscopic nephrectomy in a child: Expanding horizans for laparoscopy in a pediatric urology. J Endourol 1992;6: 463- 465.
4. Keeley FX, Gıalas I, Pıllaı M, Chrisofos M, Tolley DA. Laparoscopic ureterolithotomy: The Edinburgh experience. BJU International 1999;84: 765-769.
5. Gaur DD, Agarwal DK, Purohit KC, Darshane AS, Shah BC. Retroperitoneal laparoscopic ureterolithotomy for multiple upper mid ureteral calculi. J Urol 1994;151: 1001-1002.
6. Schuessler WW, Grune MT, Tecuanhuey LV et al. Laparoscopic dismembered pyeloplasty. J Urol 1993;150: 1795-1799.
7. Pugliese R, Boniardi M, Sansonna F, Maggioni D, De Carli S. Outcomes of laparoscopic adrenalectomy. Clinical experience with 68 patients. Surg Oncol 2008;17: 49- 57.
8. Lezoche E, Guerrieri M, Crosta F, Paganini A, D’Ambrosio G. Perioperative results of 214 laparoscopic adrenalectomies by anterior transperitoneal approach. Surg endosc 2008; 22: 522-526.
9. Nieh PT, Bihrle W. Laparoscopic marsupialization of massive renal cyst. J Urol 1993;150: 171-173.
10. Soulie M, Seguin P. Urological complications of laparoscopic surgery: Experience with 350 procedures at a single center. J Urol 2002;165: 1960-1963.
11. Deziel DJ, Millikan KW, Economou SG, et al. Complications of laparoscopic cholesistectomy: a national survey of 4292 hospitals and analysis of 77604 cases. Amer J Surg 1993;165: 9-14.
12. Linos DA, Stylopoulos N, Boukis M, Souvatzoglou A, Raptis S, Papadimitrou J. Anterior, posterior or laparoscopic approach for the management of adrenal diseases. Am J Surg 1997;173:120-125.
13. Thompson GB, Grant CS, Van Heerden JA et al. Laparoscopic versus open posterior adrenalectomy. A casecontrol study of 100 patients. Surgery 1997; 122:1132- 1136.
14. Mintz M. Risks and prophylaxis in laparoscopy: a survey of 100,000 cases. J Reprod Med 1977;18: 269-272.
15. Vallacien G, Cathelineau X, Guillonneau B. Complications of transperitoneal laparoscopic surgery in urology. Review of 1311 procedures at a single center. J Urol 2002; 168: 23-26.
16. Gomella LG, Abdel-Meguid TA, Lotfi MA, et al. Laparoscopic urologic surgery outcome assessment. J Laparoendosc Adv Surg Tech A 1997; 7: 77-86.
17. Meraney AM, Samee AA, Gill IS. Vascular and bowel complications during retroperitoneal laparoscopic surgery. J Urol 2002; 168: 1941-1944.
18. Fahlenkamp D, Rassweiler J, Fornara P, Frede T, Loening SA. Complications of laparoscopic procedures in urology: experience with 2,407 procedures at 4 German centers. J Urol 1999;162:765-770.
19. Permpongkosol S, Link RE, Su LM et al. Complications of 2,775 urological laparoscopic procedures: 1993 to 2005. J Urol 2007; 177:580-585.
20. Rassweiler JJ, Seemann O, Henkel T, Tschada R, Potempa D, Alken P. Retroperitoneoscopy. Technique and experiences with the first 100 patients. Urologe A 1996; 35: 185-195.
21. Rassweiler JJ, Frede T, Seemann O. Retroperitoneoscopy-- experiences with the first cases. Chirurg 1998; 69: 604-612.
22. Wolf JS, Marcovich R, Gill IS et al. Survey of neuromuscular injuries to the patient and surgeon during urologic laparoscopic surgery. Urology 2000; 55: 831-836.