Laparoskopik ürolojik cerrahi uygulanan 244 olgunun kısa dönem onkolojik ve fonksiyonel sonuçları: Cumhuriyet Üniversitesi deneyimi
Öz
Amaç:
Cumhuriyet Üniversitesi Sağlık Hizmetleri Uygulama ve Araştırma
Hastanesi Üroloji kliniğindeki son iki yılda gerçekleştirilen laparoskopik
girişimlerin kısa dönem onkolojik ve fonksiyonel sonuçlarını sunmaktır.
Yöntem:
Mayıs 2015 ile Şubat 2018 tarihleri arasında kliniğimizde
laparoskopik cerrahi uygulanan 13’ ü pediatrik olan toplam 244 olguya ait olan
veriler retrospektif olarak değerlendirilmiştir.
Bulgular:
Laparoskopik cerrahi yapılan hastaların 139’ u (57%) erkek, 105’
i kadın (43%) ve bu hastaların 13’ ü (5%) pediatrik olup hastaların ortalama
yaşı 52.6 ± 17.6 (1-83) idi. Hastaların 47’sine radikal nefrektomi, 46’ sına
radikal prostatatektomi, 37’sine basit nefrektomi, 35’ ine renal kist eksizyonu, 26’ sına parsiyel nefrektomi, 13’ ü pediatrik
olan 25 olguya dismembered pyeloplasti 15’ ine adrenalektomi, 8’ ine
üreterolitotomi, 2’ sine pyelolitotomi, , 2’sine sarkokolpopeksi, 1’ ine ise
inmemiş testis nedeniyle tanısal laparoskopi uygulanmıştır. Ortalama operasyon
süresi 101.9 ± 62.7 (20-270) dakika olup kanama miktarı ise ortalama 154.3 ±
138.7 (5-800) ml olarak hesaplanmıştır. Ekstraperitoneal olarak uygulanan
radikal prostatektomi haricinde diğer bütün olgularda transperitoneal yol
tercih edilmiştir. Ondördü laparoskopik radikal prostatektomi olmak üzere
yirmialtı olguda peroperatif ve/veya postoperatif dönemde kan transfüzyonu
ihtiyacı duyulmuştur. Bir olgu haricinde intraoperatif açık cerrahiye geçme
gereksinimi duyulmamıştır. Bir olguda ise postoperatif 4. günde kanama
nedeniyle laparatomi ihtiyacı olmuştur. Altı olguda yüzeyel yara yeri
enfeksiyonu gelişmiştir. Ameliyat sonrası ortalama hastanede yatış süresi 3.8 ±
2.7 (1-8) gündür. Hastalarımızın ortalama takip süresi ise 16.5 (0-33) aydır.
Sonuç: Laparoskopik ürolojik cerrahiler; teknik olarak iyi tanımlanmış,
iyi onkolojik ve fonksiyonel sonuçları olan aynı zamanda kısa yatış süresi ve
kozmetik avantajları ile günümüzde sıklıkla tercih edilen minimal invaziv
prosedürlerdir.
Anahtar Kelimeler
Laparoscopy radical prostatectomy nephrectomy adrenalectomy pyeloplasty
Kaynakça
- 1. Cortesi N, Ferrari P, Zambarda E, et al. Diagnosis of bilateral abdominal cryptorchidism by laparoscopy. Endoscopy 1976: 8; 33-4
- 2. Clayman RV, Kavoussi LR, Soper NJ, et al. Laparoscopic nephrectomy: initial case report. J Urol 1991; 146: 278–82.
- 3. Jain S, Jain SK, Kaza RCM, Singh Y. This challenging procedure has successful outcomes: Laparoscopic nephrectomy in inflammatory renal diseases. Urol Ann. 2018; 10: 35-40.
- 4. Cwach K, Kavoussi L. Past, present, and future of laparoscopic renal surgery. Investig Clin Urol 2016; 57 (Suppl 2): 110-3.
- 5. Kunert W, Storz P, Müller S, Axt S, Kirschniak A. 3D in laparoscopy: State of theart. Chirurg 2013; 84: 202-7.
- 6. Fornara P, Doehn C, Friedrich HJ, Jocham D. Nonrandomized comparison of open flank versus laparoscopic nephrectomy in 249 patients with benign renal disease. EurUrol 2001; 40: 24-31.
- 7. Gratzke C, Seitz M, Bayrle F, et al. Quality of life and perioperative outcomes after retroperitoneoscopic radical nephrectomy (RN), open RN and nephron-sparing surgery in patients with renal cell carcinoma. BJU Int 2009; 104: 470-5.
- 8. Gill IS, Kavoussi LR, Clayman RV, et al. Complications of laparoscopic nephrectomy in 185 patients: a multi institutional review. J Urol 1995; 154: 479-83.
- 9. Siqueira Jr TM, Kuo RL, GardnerTA, et al. Major complications in 213 laparoscopic nephrectomy cases: the Indianapolis experience. J Urol 2002; 168: 1361-5.
- 10. Permpongkosol S, Link RE, Su LM, et al. Complications of 2,775 Urological laparoscopic procedures: 1993–2005. J Urol 2007; 177: 580-5.
- 11. Michael S. Lasser, Reza Ghavamian. Surgical complications of laparoscopic urological surgery. Arab J Urol 2012; 10 (1): 81-8.
- 12. Jarrett TW, Chan DY, Charambura TC, Fugita O, Kavoussi LR. Laparoscopic pyeloplasty: The first 100 cases. J Urol 2002; 167: 1253-6.
- 13. Chan DY, Cadeddu JA, Jarrett TW, Marshall FF, Kavoussi LR. Laparoscopic radical nephrectomy: cancer control for renal cell carcinoma. J Urol 2001; 166: 2095-9.
- 14. Baldewijns MM, vanVlodrop IJ, Schouten LJ.et al. Genetics and epigenetics of renal cell cancer. Biochim Biophys Acta 2008; 1785: 133-55.
- 15. Gong EM, Orvieto MA, Zorn KC, et al. Comparison of laparoscopic and open partial nephrectomy in clinical T1a renal tumors. J Endourol 2008; 22: 953-7.
- 16. Shah PH, Moreira DM, Okhunov Z, et al. Positive Surgical Margins Increase Risk of Recurrence after Partial Nephrectomy for High Risk Renal Tumors. J Urol 2016; 196: 327-34.
- 17. Marszalek M, Meixl H, Polajnar M, et al. Laparoscopic and open partial nephrectomy: a matched-pair comparison of 200 patients. Eur Urol 2009; 55: 1171-8.
- 18. Parnaby CN, Chong PS, Chisholm L, et al. The role of laparoscopic adrenalectomy for adrenal tumours of 6 cm or greater. Surg Endosc 2008; 22: 617-21.
- 19. Nelson JB. Debate: open radical prostatectomy vs. laparoscopic vs. robotic. Urol Oncol 2007; 25: 490-3.
- 20. Stolzenburg JU, Rabenalt R, DO M, et al. Endoscopic extraperitoneal radical prostatectomy: oncological and functional results after 700 procedures. J Urol 2005; 174: 1271-5.
- 21. Stolzenburg JU, Rabenalt R, Do M, Kallidonis P, Liatsikos EN. Endoscopic extraperitoneal radical prostatectomy: the University of Leipzig experience of 2000 cases. J Endourol 2008; 22: 2319-25.
Oncological and functional outcomes of 244 laparoscopic urological procedures: Cumhuriyet University experience
Öz
Objective: Presenting short-term oncological and functional
outcomes of laparoscopic procedures performed in the past two years in the
Urology Department of Cumhuriyet University Health Services Training and
Research Hospital.
Method: Clinical data of a total of 244 patients, including 13
pediatric patients, who underwent laparoscopic surgery between May 2015 and
February 2018 were evaluated retrospectively.
Results: Of the patients who underwent laparoscopic surgery,
139 (57%) were male and 105 (43%) were female, 13 (5%) were pediatric and the
mean age of the patients was 52.6 ± 17.6 (1-83). Radical nephrectomy was
performed in 47 patients, radical prostatectomy was performed in 46 patients,
simple nephrectomy was performed in 37 patients, renal cyst excision was
performed in 35 patients, partial nephrectomy was performed in 26 patients,
dismembered pyeloplasty was performed in 25 patients 13 of whom were pediatric,
adrenalectomy was performed in 15 patients, ureterolithotomy was performed in 8
patients, pyelolithotomy was performed in 2 patients, sacrocolpopexy was performed in 2 patients,
and due to undescended testicle diagnosis, laparoscopy was performed in 1
patient. The mean duration of operation was 101.9 ± 62.7 (20-270) minutes and
the mean amount of bleeding was found as 154.3 ± 138.7 (5-800) ml.
Transperitoneal approach was preferred in all other cases except
extraperitoneal radical prostatectomy. Blood transfusion was required in
twenty-six cases, fourteen of which were laparoscopic radical prostatectomy in
perioperative and / or postoperative periods. There was no need for initiating
intraoperative open surgery except one case. In one case, laparotomy was
required due to bleeding on the 4th postoperative day. In six cases,
superficial wound site infection developed. The mean duration of postoperative
hospitalization was 3.8 ± 2.7 days (1-8 days). The mean follow-up period of our
patients was 16.5 (0-33) months.
Conclusions: Laparoscopic urological surgeries are frequently
preferred as minimally invasive procedures being technically well-defined, with
good oncological and functional outcomes, as well as with short hospitalization
periods and cosmetic advantages.
Anahtar Kelimeler
adrenalectomy pyeloplasty nephrectomy radical prostatectomy Laparoscopy pyeloplasty
Kaynakça
- 1. Cortesi N, Ferrari P, Zambarda E, et al. Diagnosis of bilateral abdominal cryptorchidism by laparoscopy. Endoscopy 1976: 8; 33-4
- 2. Clayman RV, Kavoussi LR, Soper NJ, et al. Laparoscopic nephrectomy: initial case report. J Urol 1991; 146: 278–82.
- 3. Jain S, Jain SK, Kaza RCM, Singh Y. This challenging procedure has successful outcomes: Laparoscopic nephrectomy in inflammatory renal diseases. Urol Ann. 2018; 10: 35-40.
- 4. Cwach K, Kavoussi L. Past, present, and future of laparoscopic renal surgery. Investig Clin Urol 2016; 57 (Suppl 2): 110-3.
- 5. Kunert W, Storz P, Müller S, Axt S, Kirschniak A. 3D in laparoscopy: State of theart. Chirurg 2013; 84: 202-7.
- 6. Fornara P, Doehn C, Friedrich HJ, Jocham D. Nonrandomized comparison of open flank versus laparoscopic nephrectomy in 249 patients with benign renal disease. EurUrol 2001; 40: 24-31.
- 7. Gratzke C, Seitz M, Bayrle F, et al. Quality of life and perioperative outcomes after retroperitoneoscopic radical nephrectomy (RN), open RN and nephron-sparing surgery in patients with renal cell carcinoma. BJU Int 2009; 104: 470-5.
- 8. Gill IS, Kavoussi LR, Clayman RV, et al. Complications of laparoscopic nephrectomy in 185 patients: a multi institutional review. J Urol 1995; 154: 479-83.
- 9. Siqueira Jr TM, Kuo RL, GardnerTA, et al. Major complications in 213 laparoscopic nephrectomy cases: the Indianapolis experience. J Urol 2002; 168: 1361-5.
- 10. Permpongkosol S, Link RE, Su LM, et al. Complications of 2,775 Urological laparoscopic procedures: 1993–2005. J Urol 2007; 177: 580-5.
- 11. Michael S. Lasser, Reza Ghavamian. Surgical complications of laparoscopic urological surgery. Arab J Urol 2012; 10 (1): 81-8.
- 12. Jarrett TW, Chan DY, Charambura TC, Fugita O, Kavoussi LR. Laparoscopic pyeloplasty: The first 100 cases. J Urol 2002; 167: 1253-6.
- 13. Chan DY, Cadeddu JA, Jarrett TW, Marshall FF, Kavoussi LR. Laparoscopic radical nephrectomy: cancer control for renal cell carcinoma. J Urol 2001; 166: 2095-9.
- 14. Baldewijns MM, vanVlodrop IJ, Schouten LJ.et al. Genetics and epigenetics of renal cell cancer. Biochim Biophys Acta 2008; 1785: 133-55.
- 15. Gong EM, Orvieto MA, Zorn KC, et al. Comparison of laparoscopic and open partial nephrectomy in clinical T1a renal tumors. J Endourol 2008; 22: 953-7.
- 16. Shah PH, Moreira DM, Okhunov Z, et al. Positive Surgical Margins Increase Risk of Recurrence after Partial Nephrectomy for High Risk Renal Tumors. J Urol 2016; 196: 327-34.
- 17. Marszalek M, Meixl H, Polajnar M, et al. Laparoscopic and open partial nephrectomy: a matched-pair comparison of 200 patients. Eur Urol 2009; 55: 1171-8.
- 18. Parnaby CN, Chong PS, Chisholm L, et al. The role of laparoscopic adrenalectomy for adrenal tumours of 6 cm or greater. Surg Endosc 2008; 22: 617-21.
- 19. Nelson JB. Debate: open radical prostatectomy vs. laparoscopic vs. robotic. Urol Oncol 2007; 25: 490-3.
- 20. Stolzenburg JU, Rabenalt R, DO M, et al. Endoscopic extraperitoneal radical prostatectomy: oncological and functional results after 700 procedures. J Urol 2005; 174: 1271-5.
- 21. Stolzenburg JU, Rabenalt R, Do M, Kallidonis P, Liatsikos EN. Endoscopic extraperitoneal radical prostatectomy: the University of Leipzig experience of 2000 cases. J Endourol 2008; 22: 2319-25.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Surgical Science Research Makaleler |
| Yazarlar | |
| Yayımlanma Tarihi | 20 Mart 2018 |
| Kabul Tarihi | 5 Mart 2018 |
| Yayımlandığı Sayı | Yıl 2018 |