The International Journal of Medical Robotics and Computer Assisted Surgery, 2018
BackgroundLimited data exist regarding adoption of evolving robotic technology in surgery. This s... more BackgroundLimited data exist regarding adoption of evolving robotic technology in surgery. This study evaluated trends and the current condition of robotic platforms in surgical specialties and general surgical subspecialties.MethodsBetween January 2013 and December 2017, all robotic operations performed in Turkey were included.ResultsIn the study period, 13 760 robotic operations were performed at 32 hospitals. The median numbers of general surgical procedures were 43and eight cases per hospital and per general surgeon, respectively. The high‐volume general surgeons performed 1734 (81%) of the cases. Forty‐five percent and 55% of the general surgical operations were performed with the Xi and S/Si robots, respectively.ConclusionUse of the Xi platform seems to increase caseload in general surgery operations possibly by facilitating robotic colorectal surgery. Targeting the high‐volume centres and surgeons for further training and implantation of upcoming robotic technology can be mor...
Spontan kolonik perforasyon, bevacizumab tedavisinin çok yüksek mortaliteyle seyreden bir komplik... more Spontan kolonik perforasyon, bevacizumab tedavisinin çok yüksek mortaliteyle seyreden bir komplikasyonu olmasına rağmen bu durumun yönetminine dair literatür verisi kısıtlıdır. Bu yazımızda, bağırsak dışı kanserler sebebiyle verilen Bevacizumab tedavisine sekonder gelişen beş spontan kolonik perforasyon vakası sunuyoruz. Sadece perfore segmenti içerecek şekilde parsiyel kolektomi uygulanan hastalar (n=3) ilerleyen abdominal sepsis nedeniyle postop birinci ay içerisinde kaybedilmişken, total kolektomi yapılan hastalar (n=2) görece daha uzun bir sağ kalım göstermiş olup nihai olarak primer hastalığın doğal seyri sonucu kaybedilmişlerdir. Bevacizumab tedavisine bağlı spontan kolonik perforasyonun patofizyolojisi de göz önünde bulundurulduğunda, total kolektomi, özellikle intraoperatif değerlendirmede kolonun perfore olmamış kısımlarının da sağlıksız görünmesi durumunda hayat kurtarıcı ve tek basamaklı bir tedavi olabilir.
Journal of Laparoendoscopic & Advanced Surgical Techniques, 2021
Background: Obesity is one of the contributing factors to technical difficulties in minimally inv... more Background: Obesity is one of the contributing factors to technical difficulties in minimally invasive colorectal surgery. However, there are no data regarding the outcomes for obese patients undergoing robotic complete mesocolic excision (CME) for colon cancer. In this study, we aimed to investigate whether robotic CME in obese patients can be performed with similar morbidity and pathological results compared with nonobese patients. Methods: Patients who underwent robotic CME between 2014 and 2019 were classified into obese and nonobese groups. Obesity was defined as body mass index ≥30 kg/m2. Demographic data, perioperative outcomes and pathological results were compared between the groups. Results: There were 42 and 105 patients in the obese and nonobese group, respectively. The groups were comparable regarding preoperative characteristics. There were no significant differences with respect to operative times (244 ± 64 versus 304 ± 75 minutes, P = .29), blood loss (median, 50 versus 80 mL, P = .20), intraoperative complications (0% versus 3.8%, P > .99), and conversions (0% versus 1.9%, P > .99). No differences were detected in length of hospital stay (6 ± 1 versus 6 ± 2 days, P = .73), anastomotic leak (2.4% versus 1.9%, P > .99), septic complications, reoperations (2.4% versus 3.8%), and readmissions (2.4% versus 2.9%) (P > .05). The mean number of harvested lymph nodes (33 ± 11 versus 34 ± 13, P = .79), resection margin status, and mesocolic fascia grading were similar. Conclusion: Robotic CME in obese patients can be performed with a similar morbidity and pathological profile compared with nonobese patients. The Clinical Trial Registration number is not applicable for this study.
SummaryPeri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this stu... more SummaryPeri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS‐CoV‐2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre‐operative SARS‐CoV‐2 infection were compared with those without previous SARS‐CoV‐2 infection. The primary outcome measure was 30‐day postoperative mortality. Logistic regression models were used to calculate adjusted 30‐day mortality rates stratified by time from diagnosis of SARS‐CoV‐2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre‐operative SARS‐CoV‐2 diagnosis. Adjusted 30‐day mortality in patients without SARS‐CoV‐2 infection was 1.5% (95%CI 1.4–1.5). In patients with a pre‐operative SARS‐CoV‐2 diagnosis, mortality was increased in patients having surgery wi...
Background This study aimed to determine the impact of pulmonary complications on death after sur... more Background This study aimed to determine the impact of pulmonary complications on death after surgery both before and during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Methods This was a patient-level, comparative analysis of two, international prospective cohort studies: one before the pandemic (January–October 2019) and the second during the SARS-CoV-2 pandemic (local emergence of COVID-19 up to 19 April 2020). Both included patients undergoing elective resection of an intra-abdominal cancer with curative intent across five surgical oncology disciplines. Patient selection and rates of 30-day postoperative pulmonary complications were compared. The primary outcome was 30-day postoperative mortality. Mediation analysis using a natural-effects model was used to estimate the proportion of deaths during the pandemic attributable to SARS-CoV-2 infection. Results This study included 7402 patients from 50 countries; 3031 (40.9 per cent) underwent surgery be...
SummarySARS‐CoV‐2 has been associated with an increased rate of venous thromboembolism in critica... more SummarySARS‐CoV‐2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri‐operative or prior SARS‐CoV‐2 were at further increased risk of venous thromboembolism. We conducted a planned sub‐study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS‐CoV‐2 diagnosis was defined as peri‐operative (7 days before to 30 days after surgery); recent (1–6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre‐operative anti‐coagulation for baseline comorbidities was no...
To support the global restart of elective surgery, data from an international prospective cohort ... more To support the global restart of elective surgery, data from an international prospective cohort study of 8492 patients (69 countries) was analysed using artificial intelligence (machine learning techniques) to develop a predictive score for mortality in surgical patients with SARS-CoV-2. We found that patient rather than operation factors were the best predictors and used these to create the COVIDsurg Mortality Score (https://covidsurgrisk.app). Our data demonstrates that it is safe to restart a wide range of surgical services for selected patients.
Introduction: The use of smaller instruments in laparoscopy has been hypothesized to reduce pain ... more Introduction: The use of smaller instruments in laparoscopy has been hypothesized to reduce pain and increase cosmesis. However, although nearly 2 decades have passed since the first mini-laparoscopic cholecystectomy (MLC), it has gained little interest. The aim of this study was to compare the outcomes of MLC with a traditional laparoscopic cholecystectomy (TLC). Materials and Methods: Patients who underwent MLC between February 6, 2016 and October 26, 2016 were included in this study. As a comparison group, patients who had TLC performed during the same period were also evaluated. The variables studied were demographic details, operating time, blood loss, postoperative pain score, length of hospital stay, and the early (<30 day) complication rate. Results: A total of 16 MLCs and 75 TLCs were performed. In the MLC group, there were 6 (37.5%) men and 10 (62.5%) women with a mean age of 40.94±12.3 years. In the comparison group, there were 35 (46.7%) men and 40 (53.3%) women with a mean age of 46.36±14.86 years. No patients were converted to open surgery. The average operating time was 47.06±15.15 minutes in the MLC group and 70.53±40.04 minutes in the TLC group (p=0.021). The average blood loss was 1.88±1.86 mL and 10.00±22.19 mL in MLC and TLC groups, respectively (p=0.005). The mean Visual Analogue Scale (VAS) score was 30.00±19.66 and 32.93±21.59, respectively, and the length of hospital stay was 1.19±0.40 days and 1.47±1.09 days in MLC and TLC groups, respectively (p=0.689 and p=0.486, correspondingly). There were 2 (2.2%) early (<30 days) postoperative complications. The mortality was nil. Conclusion: According to the results of this preliminary study, MLC was a safe and feasible variant of laparoscopic cholecystectomy. With respect to the length of hospital stay and complication rate, both procedures were equal. Additionally, a decrease in the incisional hernia rate of the "mini" ports could be hypothesized. Further studies with a larger cohort are needed.
Journal of Laparoendoscopic & Advanced Surgical Techniques, 2018
BACKGROUND This study was designed to compare the operative and short-term postoperative outcomes... more BACKGROUND This study was designed to compare the operative and short-term postoperative outcomes of the robotic and laparoscopic staplers in patients undergoing rectal surgery for cancer. MATERIALS AND METHODS Between December 2014 and April 2017, patients consecutively undergoing robotic rectal surgery for cancer were included in this study. Patients were grouped into two according to the type of staplers for rectal transection [Robotic (45-mm) versus Laparoscopic (60-mm) linear staplers]. Patient demographics, pathologic data, perioperative outcomes, and short-term results were compared. RESULTS One hundred seven patients met our inclusion criteria. The number of male patients were higher in robotic stapler group than in the laparoscopic stapler group (55% versus 76%, P = .03). Age (59 versus 63 years, P = .40), body mass index (27 versus 27 kg/m2, P = .60), American Society of Anesthesiologists score (2 versus 2, P = .20), number of prior abdominal operations (31% versus 20%, P = .22) and number of patients having neoadjuvant chemoradiotherapy (34% versus 36%, P = .86) were comparable between the groups. The numbers of cartridges used were similar regardless of the type of staplers (2 versus 2, P = .58). The overall complication was similar between the groups (24% versus 31%, P = .32). Leak rates were 5% (n = 2) and 3% (n = 2) in the robotic and laparoscopic stapler groups, respectively (p = 1). There was no mortality. CONCLUSIONS This is the first study evaluating the role of robotic stapler specifically for rectal transection in comparative manner. The use of robotic stapler for rectal transection was safe and feasible in rectal surgery for cancer.
The use of laparoscopic surgery for the surgical treatment of sigmoid diverticulitis has been res... more The use of laparoscopic surgery for the surgical treatment of sigmoid diverticulitis has been restricted due to a steep learning curve and inherent limitations including the presence of significant inflammation, bulky mesenteric tissue, the confined nature of the pelvis [1] and rarely for giant diverticulum [2]. The robotic platform represents a more recent treatment alternative for diverticular surgery and has been associated with favorable outcomes. With the introduction of da Vinci Xi in 2014 robotic surgery provides further advantages including greater range of motions, added dexterity and precision with extended operative reach in multiple quadrants [3]. This video demonstrates the feasibility of robotic sigmoidectomy for diverticular disease with the da Vinci Xi robotic platform. 29-year-old female with a history of hypothyroidism and recurrent diverticular disease was presented with progressive rightsided lower abdominal pain started a couple of days ago. Colonoscopy showed large diverticula in the sigmoid colon (8 cm in diameter). Decision was made to proceed with
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2019
In this study, we aimed to present our initial experience on totally robotic total restorative pr... more In this study, we aimed to present our initial experience on totally robotic total restorative proctocolectomy in ulcerative colitis (UC) patients. Patients undergoing a totally robotic restorative total proctocolectomy with ileal J-pouch anal anastomosis for UC between January 2015 and November 2017 were included. The da Vinci Xi was used for the operations. Patient demographics, perioperative and short-term operative outcomes were evaluated. Ten patients were included. The median operative time was 380 minutes(range, 300 to 480 min). The median blood loss was 65 mL (range, 5 to 400 mL). No conversion to open surgery was needed. The median time to flatus was 1 day (range, 1 to 2) and length of stay was 6 (4 to 12) days. Short-term complications (≤30 d) were superficial wound infection (n=3), anal bleeding (n=1), pouchitis (n=1). No mortality was observed during the study period. Our study, which is the largest series so far, reveals that totally robotic restorative proctocolectomy ...
Journal of Laparoendoscopic & Advanced Surgical Techniques, 2018
INTRODUCTION Laparoscopic complete mesocolic excision (CME) for transverse colon cancer is techni... more INTRODUCTION Laparoscopic complete mesocolic excision (CME) for transverse colon cancer is technically challenging. Robotic technology has been developed to reduce technical limitations of laparoscopy. Yet, no data are available on the role of robotic approach for CME of transverse colon cancer. The aim of this study is to evaluate the feasibility and short-term outcomes of robotic CME in this subset of colon cancer. METHODS A retrospective review of a prospectively maintained database of 29 consecutive patients undergoing robotic CME for transverse colon adenocarcinoma between December 2014 and December 2017 was performed. Data on demographics, tumor characteristics, postoperative 30-day complications, and oncologic outcomes were analyzed. RESULTS There were 21 (72%) men and 8 women with a mean age of 62.9 ± 15.6 years and a body mass index of 26.4 ± 4.8 kg/m2. Of the 29 robotic CME procedures, 12 patients underwent extended right colectomy, 10 extended left colectomy, 6 subtotal colectomy, and 1 total colectomy. The mean operative time was 321.7 ± 111.3 minutes and estimated blood loss was 106.9 ± 110.9 mL (median, 50; range, 10-400 mL). The intra- and postoperative complication rates were 7% and 24%, respectively. There were no conversions. The mean time to first bowel movement was 3.5 ± 1.3 and length of hospital stay was 7.1 ± 3.0 days. All the resections were R0. The mean number of harvested lymph nodes in extended and subtotal/total colectomy procedures was 36.6 ± 13.1 and 71.0 ± 30.3, respectively. The rate of mesocolic plane surgery was 79%. There were no statistically significant differences between the mesocolic and the intramesocolic/muscularis propria plane resections with respect to clinical characteristics, operative outcomes, and pathology results (P > .05). CONCLUSIONS Robotic CME for transverse colon cancer is feasible and can be a procedure of choice to achieve a good surgical quality.
The geographical location and differences in tumor biology significantly change the management of... more The geographical location and differences in tumor biology significantly change the management of gastric cancer. The prevalence of gastric cancer ranks fifth and sixth among men and women, respectively, in Turkey. The international guidelines from the Eastern and Western countries fail to manage a considerable amount of inconclusive issues in the management of gastric cancer. The uncertainties lead to significant heterogeneities in clinical practice, lack of homogeneous data collection, and subsequently, diverse outcomes. The physicians who are professionally involved in the management of gastric cancer at two institutions in Istanbul, Turkey, organized a consensus meeting to address current problems and plan feasible, logical, measurable, and collective solutions in their clinical practice for this challenging disease. The evidence-based data and current guidelines were reviewed. The gray zones in the management of gastric cancer were determined in the first session of this consensus meeting. The second session was constructed to discuss, vote, and ratify the ultimate decisions. The identification of the T stage, the esophagogastric area, imaging algorithm for proper staging and follow-up, timing and patient selection for neoadjuvant treatment, and management of advanced and metastatic disease have been accepted as the major issues in the management of gastric cancer. The recommendations are presented with the percentage of supporting votes in the results section with related data.
Adoption of laparoscopic surgery for cancers requiring partial or total proctectomy has been slow... more Adoption of laparoscopic surgery for cancers requiring partial or total proctectomy has been slow due to difficulty of achieving oncologically adequate resection. Obesity is a factor complicating use and outcomes of laparoscopic technique for rectal surgery. Impact of obesity on the outcomes of robotic rectal surgery for cancer is not well defined. This study is designed to assess whether if the robotic technique has potential to overcome the limitations of obesity and to improve outcomes of minimally invasive rectal surgery for cancer. Patients undergoing robotic sphincter-saving radical resection with da Vinci Xi System between December 2014 and December 2016 were included. Patients were divided into 2 groups as obese and nonobese. Patient demographics, perioperative outcomes and short-term results were compared between the groups. The study included 101 patients (30 were obese). Sex (female: 35 vs. 37%, P=0.89), American Society of Anesthesiologists score (2 vs. 2, P=0.41), numbe...
The treatment of high transsphincteric fistula is a complex procedure, which may be associated wi... more The treatment of high transsphincteric fistula is a complex procedure, which may be associated with the risk of recurrence and fecal incontinence. In this study, we used an animal model to compare different types of sphincter-preserving treatments for transsphincteric fistula. Sixteen female New Zealand rabbits, weighing 2.8-4.8 kg underwent a surgical creation of high transsphincteric fistula. After 6 weeks, magnetic resonance imaging (MRI) was performed in order to confirm fistula formation and measure the fistula diameter. The rabbits were divided into three groups. Group 1 received no plug treatment (control). Autologous dermal graft and acellular dermal matrix were used as a plug in groups 2 and 3, respectively. Five weeks after treatment, fistula tract healing was determined by measuring the largest fistula diameter with MRI. All rabbits were euthanized and the anorectum excised en bloc for histopathological examination. According to the MRI findings, all groups showed significant healing after the treatment (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). The healing rate of fistula diameters after treatment was 40, 66, and 29 % in the control, dermal graft, and acellular dermal matrix groups, respectively. In terms of negative healing parameters such as neutrophil, eosinophil, lymphocyte, and plasmocyte accumulation, dermal graft and acellular dermal matrix groups showed significantly lower results than those in the control group (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). According to MRI and histopathological results, fistula tract curettage and fistula orifice closure improved transsphincteric anal fistula healing. Additionally, in this study, plug treatment favoring autologous dermal graft resulted in better healing.
Bakirkoy Tip Dergisi / Medical Journal of Bakirkoy, 2011
Kronik hıçkırığa bağlı zor entübasyon: Olgu sunumu Hıçkırık, diafragmanın spazmı olarak tarif edi... more Kronik hıçkırığa bağlı zor entübasyon: Olgu sunumu Hıçkırık, diafragmanın spazmı olarak tarif edilir, glottis hızlı bir şekilde kapanıp ani bir inhalasyona sepep olur ve ses oluşturur. Hıçkırık; cerrahi, endoskopi, manyetik rezonans görüntüleme gibi birçok işlemin yapılmasını zorlaştırır. Literatürde hıçkırık anestezi nedeniyle gelişen bir durum olarak değerlendirilmekte ve birçok çalışma anestezi nedenli hıçkırık üzerine yoğunlaşmaktadır. Zor entübasyon nedenleri arasında, kronik hıçkırık nedeniyle ile ilgili literatür verisi sınırlıdır. Bu makalede kronik hıçkırığa bağlı zor entübe edilen bir olguyu sunmaktayız. Olguda kronik hıçkırığa eşlik eden grade 3 özofajit ve hiatal fıtık bulunmaktaydı. Hastaya laparoskopik Nissen fundoplikasyonu ve torakoskopik frenik sinir ablasyonu yapıldı. Hasta ameliyat sırasında hıçkırmaya devam etti ancak ameliyat sonrası dönemde hıçkırığın şiddeti ve sıklığı azaldı.
Poster presentations the normative values compared to 85% in NF pts (p = 0.049). No differences w... more Poster presentations the normative values compared to 85% in NF pts (p = 0.049). No differences were found in daily physical activity between F pts and NF pts. Conclusions: Physical fitness in IBD patients is impaired compared to healthy controls and particularly in fatigued patients whereas their activity level is normal. This suggests that fatigued patients might benefit from individualized fitness programs in order to lower the fatigue burden. P167 How frequent are conversions of tuberculosis (TBC) screening tests among inflammatory bowel disease (IBD) patients under anti-TNF treatment?
The International Journal of Medical Robotics and Computer Assisted Surgery, 2018
BackgroundLimited data exist regarding adoption of evolving robotic technology in surgery. This s... more BackgroundLimited data exist regarding adoption of evolving robotic technology in surgery. This study evaluated trends and the current condition of robotic platforms in surgical specialties and general surgical subspecialties.MethodsBetween January 2013 and December 2017, all robotic operations performed in Turkey were included.ResultsIn the study period, 13 760 robotic operations were performed at 32 hospitals. The median numbers of general surgical procedures were 43and eight cases per hospital and per general surgeon, respectively. The high‐volume general surgeons performed 1734 (81%) of the cases. Forty‐five percent and 55% of the general surgical operations were performed with the Xi and S/Si robots, respectively.ConclusionUse of the Xi platform seems to increase caseload in general surgery operations possibly by facilitating robotic colorectal surgery. Targeting the high‐volume centres and surgeons for further training and implantation of upcoming robotic technology can be mor...
Spontan kolonik perforasyon, bevacizumab tedavisinin çok yüksek mortaliteyle seyreden bir komplik... more Spontan kolonik perforasyon, bevacizumab tedavisinin çok yüksek mortaliteyle seyreden bir komplikasyonu olmasına rağmen bu durumun yönetminine dair literatür verisi kısıtlıdır. Bu yazımızda, bağırsak dışı kanserler sebebiyle verilen Bevacizumab tedavisine sekonder gelişen beş spontan kolonik perforasyon vakası sunuyoruz. Sadece perfore segmenti içerecek şekilde parsiyel kolektomi uygulanan hastalar (n=3) ilerleyen abdominal sepsis nedeniyle postop birinci ay içerisinde kaybedilmişken, total kolektomi yapılan hastalar (n=2) görece daha uzun bir sağ kalım göstermiş olup nihai olarak primer hastalığın doğal seyri sonucu kaybedilmişlerdir. Bevacizumab tedavisine bağlı spontan kolonik perforasyonun patofizyolojisi de göz önünde bulundurulduğunda, total kolektomi, özellikle intraoperatif değerlendirmede kolonun perfore olmamış kısımlarının da sağlıksız görünmesi durumunda hayat kurtarıcı ve tek basamaklı bir tedavi olabilir.
Journal of Laparoendoscopic & Advanced Surgical Techniques, 2021
Background: Obesity is one of the contributing factors to technical difficulties in minimally inv... more Background: Obesity is one of the contributing factors to technical difficulties in minimally invasive colorectal surgery. However, there are no data regarding the outcomes for obese patients undergoing robotic complete mesocolic excision (CME) for colon cancer. In this study, we aimed to investigate whether robotic CME in obese patients can be performed with similar morbidity and pathological results compared with nonobese patients. Methods: Patients who underwent robotic CME between 2014 and 2019 were classified into obese and nonobese groups. Obesity was defined as body mass index ≥30 kg/m2. Demographic data, perioperative outcomes and pathological results were compared between the groups. Results: There were 42 and 105 patients in the obese and nonobese group, respectively. The groups were comparable regarding preoperative characteristics. There were no significant differences with respect to operative times (244 ± 64 versus 304 ± 75 minutes, P = .29), blood loss (median, 50 versus 80 mL, P = .20), intraoperative complications (0% versus 3.8%, P > .99), and conversions (0% versus 1.9%, P > .99). No differences were detected in length of hospital stay (6 ± 1 versus 6 ± 2 days, P = .73), anastomotic leak (2.4% versus 1.9%, P > .99), septic complications, reoperations (2.4% versus 3.8%), and readmissions (2.4% versus 2.9%) (P > .05). The mean number of harvested lymph nodes (33 ± 11 versus 34 ± 13, P = .79), resection margin status, and mesocolic fascia grading were similar. Conclusion: Robotic CME in obese patients can be performed with a similar morbidity and pathological profile compared with nonobese patients. The Clinical Trial Registration number is not applicable for this study.
SummaryPeri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this stu... more SummaryPeri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS‐CoV‐2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre‐operative SARS‐CoV‐2 infection were compared with those without previous SARS‐CoV‐2 infection. The primary outcome measure was 30‐day postoperative mortality. Logistic regression models were used to calculate adjusted 30‐day mortality rates stratified by time from diagnosis of SARS‐CoV‐2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre‐operative SARS‐CoV‐2 diagnosis. Adjusted 30‐day mortality in patients without SARS‐CoV‐2 infection was 1.5% (95%CI 1.4–1.5). In patients with a pre‐operative SARS‐CoV‐2 diagnosis, mortality was increased in patients having surgery wi...
Background This study aimed to determine the impact of pulmonary complications on death after sur... more Background This study aimed to determine the impact of pulmonary complications on death after surgery both before and during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Methods This was a patient-level, comparative analysis of two, international prospective cohort studies: one before the pandemic (January–October 2019) and the second during the SARS-CoV-2 pandemic (local emergence of COVID-19 up to 19 April 2020). Both included patients undergoing elective resection of an intra-abdominal cancer with curative intent across five surgical oncology disciplines. Patient selection and rates of 30-day postoperative pulmonary complications were compared. The primary outcome was 30-day postoperative mortality. Mediation analysis using a natural-effects model was used to estimate the proportion of deaths during the pandemic attributable to SARS-CoV-2 infection. Results This study included 7402 patients from 50 countries; 3031 (40.9 per cent) underwent surgery be...
SummarySARS‐CoV‐2 has been associated with an increased rate of venous thromboembolism in critica... more SummarySARS‐CoV‐2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri‐operative or prior SARS‐CoV‐2 were at further increased risk of venous thromboembolism. We conducted a planned sub‐study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS‐CoV‐2 diagnosis was defined as peri‐operative (7 days before to 30 days after surgery); recent (1–6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre‐operative anti‐coagulation for baseline comorbidities was no...
To support the global restart of elective surgery, data from an international prospective cohort ... more To support the global restart of elective surgery, data from an international prospective cohort study of 8492 patients (69 countries) was analysed using artificial intelligence (machine learning techniques) to develop a predictive score for mortality in surgical patients with SARS-CoV-2. We found that patient rather than operation factors were the best predictors and used these to create the COVIDsurg Mortality Score (https://covidsurgrisk.app). Our data demonstrates that it is safe to restart a wide range of surgical services for selected patients.
Introduction: The use of smaller instruments in laparoscopy has been hypothesized to reduce pain ... more Introduction: The use of smaller instruments in laparoscopy has been hypothesized to reduce pain and increase cosmesis. However, although nearly 2 decades have passed since the first mini-laparoscopic cholecystectomy (MLC), it has gained little interest. The aim of this study was to compare the outcomes of MLC with a traditional laparoscopic cholecystectomy (TLC). Materials and Methods: Patients who underwent MLC between February 6, 2016 and October 26, 2016 were included in this study. As a comparison group, patients who had TLC performed during the same period were also evaluated. The variables studied were demographic details, operating time, blood loss, postoperative pain score, length of hospital stay, and the early (<30 day) complication rate. Results: A total of 16 MLCs and 75 TLCs were performed. In the MLC group, there were 6 (37.5%) men and 10 (62.5%) women with a mean age of 40.94±12.3 years. In the comparison group, there were 35 (46.7%) men and 40 (53.3%) women with a mean age of 46.36±14.86 years. No patients were converted to open surgery. The average operating time was 47.06±15.15 minutes in the MLC group and 70.53±40.04 minutes in the TLC group (p=0.021). The average blood loss was 1.88±1.86 mL and 10.00±22.19 mL in MLC and TLC groups, respectively (p=0.005). The mean Visual Analogue Scale (VAS) score was 30.00±19.66 and 32.93±21.59, respectively, and the length of hospital stay was 1.19±0.40 days and 1.47±1.09 days in MLC and TLC groups, respectively (p=0.689 and p=0.486, correspondingly). There were 2 (2.2%) early (<30 days) postoperative complications. The mortality was nil. Conclusion: According to the results of this preliminary study, MLC was a safe and feasible variant of laparoscopic cholecystectomy. With respect to the length of hospital stay and complication rate, both procedures were equal. Additionally, a decrease in the incisional hernia rate of the "mini" ports could be hypothesized. Further studies with a larger cohort are needed.
Journal of Laparoendoscopic & Advanced Surgical Techniques, 2018
BACKGROUND This study was designed to compare the operative and short-term postoperative outcomes... more BACKGROUND This study was designed to compare the operative and short-term postoperative outcomes of the robotic and laparoscopic staplers in patients undergoing rectal surgery for cancer. MATERIALS AND METHODS Between December 2014 and April 2017, patients consecutively undergoing robotic rectal surgery for cancer were included in this study. Patients were grouped into two according to the type of staplers for rectal transection [Robotic (45-mm) versus Laparoscopic (60-mm) linear staplers]. Patient demographics, pathologic data, perioperative outcomes, and short-term results were compared. RESULTS One hundred seven patients met our inclusion criteria. The number of male patients were higher in robotic stapler group than in the laparoscopic stapler group (55% versus 76%, P = .03). Age (59 versus 63 years, P = .40), body mass index (27 versus 27 kg/m2, P = .60), American Society of Anesthesiologists score (2 versus 2, P = .20), number of prior abdominal operations (31% versus 20%, P = .22) and number of patients having neoadjuvant chemoradiotherapy (34% versus 36%, P = .86) were comparable between the groups. The numbers of cartridges used were similar regardless of the type of staplers (2 versus 2, P = .58). The overall complication was similar between the groups (24% versus 31%, P = .32). Leak rates were 5% (n = 2) and 3% (n = 2) in the robotic and laparoscopic stapler groups, respectively (p = 1). There was no mortality. CONCLUSIONS This is the first study evaluating the role of robotic stapler specifically for rectal transection in comparative manner. The use of robotic stapler for rectal transection was safe and feasible in rectal surgery for cancer.
The use of laparoscopic surgery for the surgical treatment of sigmoid diverticulitis has been res... more The use of laparoscopic surgery for the surgical treatment of sigmoid diverticulitis has been restricted due to a steep learning curve and inherent limitations including the presence of significant inflammation, bulky mesenteric tissue, the confined nature of the pelvis [1] and rarely for giant diverticulum [2]. The robotic platform represents a more recent treatment alternative for diverticular surgery and has been associated with favorable outcomes. With the introduction of da Vinci Xi in 2014 robotic surgery provides further advantages including greater range of motions, added dexterity and precision with extended operative reach in multiple quadrants [3]. This video demonstrates the feasibility of robotic sigmoidectomy for diverticular disease with the da Vinci Xi robotic platform. 29-year-old female with a history of hypothyroidism and recurrent diverticular disease was presented with progressive rightsided lower abdominal pain started a couple of days ago. Colonoscopy showed large diverticula in the sigmoid colon (8 cm in diameter). Decision was made to proceed with
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2019
In this study, we aimed to present our initial experience on totally robotic total restorative pr... more In this study, we aimed to present our initial experience on totally robotic total restorative proctocolectomy in ulcerative colitis (UC) patients. Patients undergoing a totally robotic restorative total proctocolectomy with ileal J-pouch anal anastomosis for UC between January 2015 and November 2017 were included. The da Vinci Xi was used for the operations. Patient demographics, perioperative and short-term operative outcomes were evaluated. Ten patients were included. The median operative time was 380 minutes(range, 300 to 480 min). The median blood loss was 65 mL (range, 5 to 400 mL). No conversion to open surgery was needed. The median time to flatus was 1 day (range, 1 to 2) and length of stay was 6 (4 to 12) days. Short-term complications (≤30 d) were superficial wound infection (n=3), anal bleeding (n=1), pouchitis (n=1). No mortality was observed during the study period. Our study, which is the largest series so far, reveals that totally robotic restorative proctocolectomy ...
Journal of Laparoendoscopic & Advanced Surgical Techniques, 2018
INTRODUCTION Laparoscopic complete mesocolic excision (CME) for transverse colon cancer is techni... more INTRODUCTION Laparoscopic complete mesocolic excision (CME) for transverse colon cancer is technically challenging. Robotic technology has been developed to reduce technical limitations of laparoscopy. Yet, no data are available on the role of robotic approach for CME of transverse colon cancer. The aim of this study is to evaluate the feasibility and short-term outcomes of robotic CME in this subset of colon cancer. METHODS A retrospective review of a prospectively maintained database of 29 consecutive patients undergoing robotic CME for transverse colon adenocarcinoma between December 2014 and December 2017 was performed. Data on demographics, tumor characteristics, postoperative 30-day complications, and oncologic outcomes were analyzed. RESULTS There were 21 (72%) men and 8 women with a mean age of 62.9 ± 15.6 years and a body mass index of 26.4 ± 4.8 kg/m2. Of the 29 robotic CME procedures, 12 patients underwent extended right colectomy, 10 extended left colectomy, 6 subtotal colectomy, and 1 total colectomy. The mean operative time was 321.7 ± 111.3 minutes and estimated blood loss was 106.9 ± 110.9 mL (median, 50; range, 10-400 mL). The intra- and postoperative complication rates were 7% and 24%, respectively. There were no conversions. The mean time to first bowel movement was 3.5 ± 1.3 and length of hospital stay was 7.1 ± 3.0 days. All the resections were R0. The mean number of harvested lymph nodes in extended and subtotal/total colectomy procedures was 36.6 ± 13.1 and 71.0 ± 30.3, respectively. The rate of mesocolic plane surgery was 79%. There were no statistically significant differences between the mesocolic and the intramesocolic/muscularis propria plane resections with respect to clinical characteristics, operative outcomes, and pathology results (P > .05). CONCLUSIONS Robotic CME for transverse colon cancer is feasible and can be a procedure of choice to achieve a good surgical quality.
The geographical location and differences in tumor biology significantly change the management of... more The geographical location and differences in tumor biology significantly change the management of gastric cancer. The prevalence of gastric cancer ranks fifth and sixth among men and women, respectively, in Turkey. The international guidelines from the Eastern and Western countries fail to manage a considerable amount of inconclusive issues in the management of gastric cancer. The uncertainties lead to significant heterogeneities in clinical practice, lack of homogeneous data collection, and subsequently, diverse outcomes. The physicians who are professionally involved in the management of gastric cancer at two institutions in Istanbul, Turkey, organized a consensus meeting to address current problems and plan feasible, logical, measurable, and collective solutions in their clinical practice for this challenging disease. The evidence-based data and current guidelines were reviewed. The gray zones in the management of gastric cancer were determined in the first session of this consensus meeting. The second session was constructed to discuss, vote, and ratify the ultimate decisions. The identification of the T stage, the esophagogastric area, imaging algorithm for proper staging and follow-up, timing and patient selection for neoadjuvant treatment, and management of advanced and metastatic disease have been accepted as the major issues in the management of gastric cancer. The recommendations are presented with the percentage of supporting votes in the results section with related data.
Adoption of laparoscopic surgery for cancers requiring partial or total proctectomy has been slow... more Adoption of laparoscopic surgery for cancers requiring partial or total proctectomy has been slow due to difficulty of achieving oncologically adequate resection. Obesity is a factor complicating use and outcomes of laparoscopic technique for rectal surgery. Impact of obesity on the outcomes of robotic rectal surgery for cancer is not well defined. This study is designed to assess whether if the robotic technique has potential to overcome the limitations of obesity and to improve outcomes of minimally invasive rectal surgery for cancer. Patients undergoing robotic sphincter-saving radical resection with da Vinci Xi System between December 2014 and December 2016 were included. Patients were divided into 2 groups as obese and nonobese. Patient demographics, perioperative outcomes and short-term results were compared between the groups. The study included 101 patients (30 were obese). Sex (female: 35 vs. 37%, P=0.89), American Society of Anesthesiologists score (2 vs. 2, P=0.41), numbe...
The treatment of high transsphincteric fistula is a complex procedure, which may be associated wi... more The treatment of high transsphincteric fistula is a complex procedure, which may be associated with the risk of recurrence and fecal incontinence. In this study, we used an animal model to compare different types of sphincter-preserving treatments for transsphincteric fistula. Sixteen female New Zealand rabbits, weighing 2.8-4.8 kg underwent a surgical creation of high transsphincteric fistula. After 6 weeks, magnetic resonance imaging (MRI) was performed in order to confirm fistula formation and measure the fistula diameter. The rabbits were divided into three groups. Group 1 received no plug treatment (control). Autologous dermal graft and acellular dermal matrix were used as a plug in groups 2 and 3, respectively. Five weeks after treatment, fistula tract healing was determined by measuring the largest fistula diameter with MRI. All rabbits were euthanized and the anorectum excised en bloc for histopathological examination. According to the MRI findings, all groups showed significant healing after the treatment (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). The healing rate of fistula diameters after treatment was 40, 66, and 29 % in the control, dermal graft, and acellular dermal matrix groups, respectively. In terms of negative healing parameters such as neutrophil, eosinophil, lymphocyte, and plasmocyte accumulation, dermal graft and acellular dermal matrix groups showed significantly lower results than those in the control group (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). According to MRI and histopathological results, fistula tract curettage and fistula orifice closure improved transsphincteric anal fistula healing. Additionally, in this study, plug treatment favoring autologous dermal graft resulted in better healing.
Bakirkoy Tip Dergisi / Medical Journal of Bakirkoy, 2011
Kronik hıçkırığa bağlı zor entübasyon: Olgu sunumu Hıçkırık, diafragmanın spazmı olarak tarif edi... more Kronik hıçkırığa bağlı zor entübasyon: Olgu sunumu Hıçkırık, diafragmanın spazmı olarak tarif edilir, glottis hızlı bir şekilde kapanıp ani bir inhalasyona sepep olur ve ses oluşturur. Hıçkırık; cerrahi, endoskopi, manyetik rezonans görüntüleme gibi birçok işlemin yapılmasını zorlaştırır. Literatürde hıçkırık anestezi nedeniyle gelişen bir durum olarak değerlendirilmekte ve birçok çalışma anestezi nedenli hıçkırık üzerine yoğunlaşmaktadır. Zor entübasyon nedenleri arasında, kronik hıçkırık nedeniyle ile ilgili literatür verisi sınırlıdır. Bu makalede kronik hıçkırığa bağlı zor entübe edilen bir olguyu sunmaktayız. Olguda kronik hıçkırığa eşlik eden grade 3 özofajit ve hiatal fıtık bulunmaktaydı. Hastaya laparoskopik Nissen fundoplikasyonu ve torakoskopik frenik sinir ablasyonu yapıldı. Hasta ameliyat sırasında hıçkırmaya devam etti ancak ameliyat sonrası dönemde hıçkırığın şiddeti ve sıklığı azaldı.
Poster presentations the normative values compared to 85% in NF pts (p = 0.049). No differences w... more Poster presentations the normative values compared to 85% in NF pts (p = 0.049). No differences were found in daily physical activity between F pts and NF pts. Conclusions: Physical fitness in IBD patients is impaired compared to healthy controls and particularly in fatigued patients whereas their activity level is normal. This suggests that fatigued patients might benefit from individualized fitness programs in order to lower the fatigue burden. P167 How frequent are conversions of tuberculosis (TBC) screening tests among inflammatory bowel disease (IBD) patients under anti-TNF treatment?
Uploads
Papers by Bilgi Baca