Hacı İbrahim ÇİMEN, Yavuz Tarık ATİK, Burak UYSAL, Fikret HALİS, Ahmet GÖKÇE, Hasan Salih SAĞLAM

Sakarya Üniversitesi’ nde Laparoskopik Ürolojik Cerrahi: Başlangıç Deneyimlerimiz

Amaç: Laparoskopik ürolojik cerrahideki başlangıç deneyimlerimizi değerlendirmek. Gereç ve Yöntemler: Ocak 2015 ile Ocak 2018 tarihleri arasında laparoskopik ürolojik cerrahi uygulanan hastaların sonuçları retrospektif olarak değerlendirilmiştir. Bulgular: Kliniğimizde laparoskopik cerrahi yapılan 88 hastanın 50’ si (%56.8) erkek, 38’ i (%43.2) kadındı. Hastaların ortalama yaşı 56 ± 14 (17-86) yıl idi. Otuz altı hastaya radikal nefrektomi, 26 hastaya basit nefrektomi, 3 hastaya parsiyel nefrektomi, 9 hastaya nefroüreterektomi, 2 hastaya dismembered pyeloplasti, 4 hastaya adrenalektomi, 7 hastaya üreterolitotomi, 1 hastaya ise orşiektomi uygulandı. Ortalama operasyon süresi sırasıyla 130±20, 119±21, 140±5, 150±21, 117±3, 71±8, 80±11 ve 45 dk, ortalama hastanede kalış süreleri sırasıyla 4.2±1.3, 3.1±1.4, 4.3±1.5, 4.7±1.3, 4±1.4, 3±0.8, 2.8±1 ve 1 gündü. Radikal nefrektomi yapılan hastaların 4’ ünde, basit nefrektomi yapılan hastaların 6’ sında ve nefroüreterektomi yapılan hastaların 3’ ünde olmak üzere toplam 13 (%14,7) hastada açık cerrahiye geçildi. Postoperatif komplikasyon 11 (%12,5) hastada görüldü. Sonuç: Laparoskopik cerrahi; öğrenme eğrisi uzun olan, cerrahın yeteneğine ve tecrübesine bağlı olarak çok iyi fonksiyonel sonuçlar veren minimal invaziv cerrahi yöntemlerden birisi olarak başlangıç döneminde uygun hasta seçimi ve doğru planlama ile başarılı bir şekilde uygulanabilmektedir.

Anahtar Kelimeler:

Laparoskopik cerrahi, üroloji, deneyim

Laparoscopic Urological Surgery In Sakarya University: Our Initial Experience

Objective: To evaluate our initial experience in laparoscopic urological surgery.Materials and Methods: The results of patients who underwent laparoscopic surgery between January 2015 and January 2018 were retrospectively evaluated.Results: Of the 88 patients, 50 (56.8%) were male and 38 (43.2%) were female. The mean age of the patients was 56 ± 14 (17-86) years. Surgical procedures were radical nephrectomy in 36 patients, simple nephrectomy in 26 patients, partial nephrectomy in 3 patients, nephroureterectomy in 9 patients, dismembered pyeloplasty in 2 patients, adrenalectomy in 4 patients, ureterolithotomy in 7 patients, and orchiectomy in 1 patient. The mean operation time was 130±20, 119±21, 140±5, 150±21, 117±3, 71±8, 80±11 and 45 minutes, respectively. The mean length of hospital stay was 4.2 ± 1.3, 3.1 ± 1.4, 4.3 ± 1.5, 4.7 ± 1.3, 4 ± 1.4, 3 ± 0.8, 2.8 ± 1 and 1 days, respectively. Conversion to open surgery was required in 13 (14.7%) patients including 4 patients underwent radical nephrectomy, 6 patients underwent simple nephrectomy and 3 patients underwent nephroureterectomy. Postoperative complications were observed in 11 (12.5%) patients. Conclusion: Laparoscopic surgery, which is a minimal invasive surgery, has a long learning curve but it can be performed successfully due to the experience and ability of a surgeon with a suitable patient choice and correct planning at the beginning.

Keywords:

Laparoscopic surgery, urology, experience,

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1. Gill IS, Clayman RV, McDougall EM. Advances in urological laparoscopy. J Urol 1995; 154: 1275-1294.
2. Cimen HI, Atik YT, Adsan O. Laparoscopic simple nephrectomy patient with situs inversus totalis and left renal hypoplasia: A case report. Can Urol Assoc J 2015; 9: 521- 523.
3. Abdelshehid CS, Eichel L, Lee D, Uribe C, Boker J, Basillote J et al. Current trends in urologic laparoscopic surgery. J Endourol 2005; 19: 15–20.
4. Gozen AS, Akin Y. Are structured curriculums for laparoscopic training useful? A review of current literature. Curr Opin Urol 2015; 25(2): 163–167.
5. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD et al. The Clavien-Dindo classification of surgical complications: five year experience. Ann Surg 2009; 250: 187-196.
6. Rabbani F, Yunis LH, Pinochet R, Nogueira L, Vora KC, Eastham JA et al. Comprehensive standardized report of complications of retropubic and laparoscopic radical prostatectomy. Eur Urol 2010; 57: 371-386.
7. de la Rosette JJ, Opondo D, Daels FP, Giusti G, Serrano A, Kandasami SV et al. Categorisation of complications and validation of the Clavien score for percutaneous nephrolithotomy. Eur Urol 2012; 62: 246-255.
8. 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: 765-771.
9. Parsons JK, Varkarakis I, Rha KH, Jarrett TW, Pinto PA, Kavoussi LR. Complications of abdominal urologic laparoscopy: longitudinal five-year analysis. Urology 2004; 63: 27-32.
10. Gomella LG, Abdel-Meguid TA, Lotfi MA, Hirsch IH, Albala D, Manyak M et al. Laparoscopic urologic surgery outcome assessment. J Laparoendosc Adv Surg Tech A 1997; 7: 77-86.
11. Lasser MS, Ghavamian R. Surgical complications of laparoscopic urological surgery. Arab J Urol. 2012; 10(1): 81–88.
12. Rassweiler JJ, Seemann O, Frede T, Henkel TO, Alken P. Retroperitoneoscopy: experience with 200 cases. J Urol 1998; 160(4): 1265-1269.
13. Permpongkosol, S, Link, RE, Su, LM, Romero FR, Bagga HS, Pavlovic CP et al. Complications of 2,775 urological laparoscopic procedures: 1993 to 2005. J Urol 2007; 177: 580–585.
14. Guillonneau B, Abbou CC, Doublet JD, Gaston R, Janetschek G, Mandressi A et al. Proposal for a European Scoring System for laparoscopic operations in urology. Eur Urol, 2001; 40: 2-6.
15. Vallancien G, Cathelineau X, Baumert H, Doublet JD, Guillonneau B. Complications of transperitoneal laparoscopic surgery in urology: review of 1,311 procedures at a single center. J Urol 2002; 168: 23–26.
16. Tuncel A, Balcı M, Köseoğlu E, Aslan Y, Güzel Ö, Keten T et al. Transperitoneal laparoscopic adrenalectomy: five years’ experience with 35 patients. Turk J Urol 2013; 39: 214–219.
17. Zacharias M, Haese A, Jurczok A, Stolzenburg JU, Fornara P. Transperitoneal laparoscopic adrenalectomy:outline of the preoperative management, surgical approach and outcome. Eur Urol 2006; 49: 448-459.
18. Kural AR, Demirkesen O, Akpınar H, Tüfek I, Yalçın V, Özkan B. Laparoskopik nefrektomide başlangıç deneyimlerimiz. Türk Üroloji Derg 2004; 30: 414- 421.
19. Rassweiler J, Fornara P, Weber M, Janetschek G, Fahlenkamp D, Henkel T et al. Laparoscopic nephrectomy: the experience of the laparoscopic working group of the German Urological Association. J Urol 1998; 160: 18-21.
20. Hatipoğlu NK, Penbegül N, Söylemez H, Atar M, Bozkurt Y, Sancaktutar AA et al. Ürolojik Laparoskopik Cerrahi: Dicle üniversitesindeki ilk 100 deneyimimiz. J Clin Exp Invest 2012; 3(1): 44-48.