Laparoskopik ürolojik cerrahi uygulanan 244 olgunun kısa dönem onkolojik ve fonksiyonel sonuçları: Cumhuriyet Üniversitesi deneyimi

Abstract

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 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 dakika olup kanama miktarı ise ortalama 154.3 ± 138.7 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 gündür. Hastalarımızın ortalama takip süresi ise 16.5 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.

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 . 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 minutes and the mean amount of bleeding was found as 154.3 ± 138.7 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 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.