Ilknur Erguner

What have we gained by performing robotic rectal resection? Evaluation of 64 consecutive patients who underwent laparoscopic or robotic low anterior resection for rectal adenocarcinoma.

Background: Robotic surgery is thought to be a solution to overcome the limitations of laparoscopy in sphincter-saving resections. In this study, we present our results on patients undergoing robotic and laparoscopic low anterior resection (LAR) consecutively for rectal adenocarcinoma. Materials and Methods: Between February 2008 and June 2011, consecutive patients who underwent laparoscopic or robotic LAR by a single surgical team for rectal cancer were evaluated. The patients’ demographic, operative, postoperative short-term follow-up, and histopathologic data were analyzed. Results: Twenty-seven patients underwent robotic LAR, whereas 37 patients underwent laparoscopic LAR. The operation time of the laparoscopy group was significantly shorter than that of the robotic group (P=0.02). The complete total mesorectal excision rate was significantly higher in the robotic group (P=0.02). The overall complication rates were 11.11% and 21.62% in the robotic and laparoscopy groups, respectively (P=0.45). Conclusions: Good quality of resected specimens could be achieved with robotic LAR. Further prospective studies including long-term oncologic outcomes and costs with higher patient number are definitely needed to assess the benefits of robotic resection in rectal cancer treatment.

Is da Vinci Xi Better than da Vinci Si in Robotic Rectal Cancer Surgery? Comparison of the 2 Generations of da Vinci Systems.

Background: We aimed to compare perioperative outcomes for procedures using the latest generation of da Vinci robot versus its previous version in rectal cancer surgery. Patients and Methods: Fifty-three patients undergoing robotic rectal cancer surgery between January 2010 and March 2015 were included. Patients were classified into 2 groups (Xi, n=28 vs. Si, n=25) and perioperative outcomes were analyzed. Results: The groups had significant differences including operative procedure, hybrid technique and redocking (P>0.05). In univariate analysis, the Xi group had shorter console times (265.7 vs. 317.1 min, P=0.006) and total operative times (321.6 vs. 360.4 min, P=0.04) and higher number of lymph nodes harvested (27.5 vs. 17.0, P=0.008). In multivariate analysis, Xi robot was associated with a shorter console time (odds ratio: 0.09, P=0.004) with no significant differences regarding other outcomes. Conclusions: Both generations of da Vinci robot led to similar short-term outcomes in rectal cancer surgery, but the Xi robot allowed shorter console times.

Total laparoscopic approach for the treatment of right colon cancer: A technical critique

BACKGROUND AND AIMS Total laparoscopic surgery is not a new concept, but it is not preferred generally for right colectomy. The aim of the study is to evaluate the outcomes, which are related with surgical technique after total laparoscopic right colectomy (TLRC) and laparoscopic-assisted right colectomy (LARC) for right colon cancer in 30 consecutive patients. MATERIALS AND METHODS Thirty patients with right colon cancer, half of which were treated with TLRC and half of which were treated with LARC, were compared with regard to patient demographics, operative and postoperative data, histopathologic findings, follow-up data, and the complications related to the surgical technique. RESULTS There were 16 men and 14 women, median age was 63 years (range 41-86) with a body mass index (BMI) of 27 kg/m2 (range 20-33). There were no differences between the groups for BMI, harvested lymph node number, or distal and radial margins. The length of the incision and the length of the postoperative stay was shorter in the TLRC group (p=0.000). Overall complications were higher in the LARC group than in the TLRC group (p=0.014). The median follow-up was 28 months (range 5-99). In the late period, two patients in the LARC group were reoperated on. The cause of reoperation was internal herniation in one patient due to ileal twisting and incisional hernia in the other one. CONCLUSION Our preliminary data indicate that TLRC could result in better outcomes for right colon cancer patients than LARC.

Robotic complete mesocolic excision for right-sided colon cancer.

Complete mesocolic excision (CME) with central vascular ligation for right-sided colon cancer has been proven to provide superior oncologic outcomes and survival advantage when compared to standard lymphadenectomy [1]. A number of studies comparing conventional laparoscopic versus open CME have shown feasibility and safety of the laparoscopic approach with acceptable oncological profile and postoperative outcomes [2, 3]. The introduction of robotic systems with its technical advantages, including improved vision, better ergonomics and precise dissection, has further revolutionized minimally invasive approach in colorectal surgery. However, there seems to be a relatively slow adoption of robotic approach in the CME technique for right-sided colon cancer. This video demonstrates our detailed operative technique and feasibility for performing right-sided CME robotically. The surgical procedure is performed with a medial-to-lateral approach through four 8-mm robotic and one assistant ports. First, the ileocolic vessels are isolated, clipped and transected near their origins. Cephalad dissection continues along the ventral aspect of the superior mesenteric vein. Staying in the embryological planes between the mesocolon and retroperitoneal structures, mesenteric dissection is extended up to the root of the right colic vessels, if present, and the middle colic vessels, which are clipped and divided individually near their origins. After the terminal ileum is transected using an endolinear staple, the colon is mobilized fully from gastrocolic tissue and then from its lateral attachments. The transverse colon is transected under the guidance of near-infrared fluorescence imaging. Creation of an intracorporeal side-to-side ileotransversostomy anastomosis and extraction of the specimen complete the operation. We consider robotic CME to be feasible, safe and oncologically adequate for the treatment of right-sided colon cancer. Its technical advantages may lead to further dissemination of the robotic approach and better standardization of this surgical technique.

Robotic Complete Mesocolic Excision for Splenic Flexure of Colon Cancer

Robotic surgery, with its enhanced dexterity and increased range of motion, is being increasingly used in colorectal surgery. In addition to the rectal approaches, where laparoscopic limitations are overcome by the dexterity and superior vision of robotics, colon cancer procedures could also be perf

Increased Caseload Volume is Associated With Better Oncologic Outcomes After Laparoscopic Resections for Colorectal Cancer.

Purpose: To evaluate the impact of caseload volume on the outcomes of open and laparoscopic surgery for colorectal cancer. Methods: Between April 1999 and January 2011, patients who underwent open or laparoscopic resection for colorectal adenocarcinoma with curative intent were identified. There were 2 groups of surgeons, whose primary practice is gastrointestinal surgery (n=5, group A) and general surgery (n=14, group B). Histopathologic and oncologic outcomes, as well as survival data were evaluated. Results: A total of 815 patients fulfilled the study criteria and 356 (group A: 120, group B: 236) patients who had >2 years’ follow-up data were included. Colorectal procedures constituted 33% and 19% of all the operations in A and B groups, respectively (P<0.0001). Among the colorectal cases, rates of laparoscopic surgery were 37% and 20% in the group A and B, respectively (P<0.0001). Practice pattern was independently associated with better overall survival and was favoring the group A (P=0.02). Conclusions: Increased caseload volume improves oncologic outcomes in patients undergoing colorectal resection for nonmetastatic cancer.

Endoscopic-assisted Robotic Aortic Thrombectomy and Aortobiiliac Bypass: A Case Report

In this report, not only our experience with laparoscopy-assisted robotic aortic thrombectomy and aortobiiliac bypass procedure was presented but also current status of vascular interventions via endoscopically was discussed.

Distribution of HLA antigens in breast cancer.

Investigation of various tumor-specific markers has a critical role in early diagnosis and treatment of breast cancer. The aim of the this study is to investigate the Human Leukocyte Antigen (HLA) alleles, the molecules that play an important role in immunity and tumor response of the body, and its relationship with breast cancer. In this prospective clinical study, after obtaining approval from the ethics committee of Istanbul University Experimental Medical Research Institute, 22 female patients who have been hospitalized in Istanbul University Cerrahpasa Faculty of Medicine the Department of General Surgery with a diagnosis of breast cancer were selected. In the control group, there were 22 healthy women who had no relationship and were donor candidates for renal transplantation. After collecting blood in 5 ml tubes with EDTA, HLA A, B and DR groups were measured with SSP method using the GenoVision Olerup SSP (Olerup SSP, Stockholm, Sweden) kit in Istanbul University Cerrahpasa Faculty of Medicine Blood Center Tissue Type Determination Laboratory. In patient and control group, totally 53 alleles; 17 alleles of HLA-A gene, 22 alleles of B gene, 14 alleles of DR gene were detected. A statistically significant relationship was determined between HLA-B55:01 and HLA-DRb1*18:01 alleles and the development of breast cancer (p<0.05). HLA-B13:01 antigen is determined only in the control group. It was concluded that HLA-B13:01 antigen, determined only in the control group, may be protective for breast cancer and HLA-B55:01 and HLA-DRb1*18:01 antigens, determined only in the patient group, may be a risk factor for breast cancer (Tab. 5, Ref. 22).