Mehmet Kemal Öztekin

Single-site robotic total hysterectomy: standardization of technique and surgical outcomes.

STUDY OBJECTIVES To evaluate the safety and feasibility of robotic single-site total hysterectomy and to compare the outcomes of newly implemented robotic single-site bipolar and external vessel-sealing device. DESIGN Retrospective study (Canadian Task Force classification II-1). SETTING University hospital. PATIENTS Twenty-four patients with benign indications for hysterectomy. INTERVENTIONS All patients underwent robotic-assisted single-incision transumbilical total hysterectomy using the novel da Vinci Single-Site Platform. Vaginal cuff closures were performed intracorporeally using the same technique in all cases. MEASUREMENTS AND MAIN RESULTS The median age of the patients was 49.5 years (range, 40-61), and body mass index was 28.5 (range, 21-34). Blood loss was 22.5 mL (range, 7-120 mL). Docking time was 5.5 minutes (range, 3-10 minutes), console time was 74.5 minutes (range, 60-160 minutes), vaginal cuff closure time was 25 minutes (range, 16-41 minutes), and total operative time was 98.5 minutes (range, 71-183 minutes). When 2 groups were created according to the energy devices used during the procedures, console time in the newly implemented bipolar group was shorter than in the external sealing device group (69.5 minutes vs. 77 minutes; p = .03); however, no differences were found for uterus removal time (50.5 minutes vs. 53.5 minutes; p = .13). Differences were observed in vaginal cuff closure time (18.5 minutes vs 23 minutes; p = .01). CONCLUSION Robotic single-site total hysterectomy using a newly implemented bipolar grasping instrument and even with intracorporeal cuff closure is a safe and feasible procedure in appropriately selected patients.

Robotic single-incision transumbilical total hysterectomy using a single-site robotic platform: initial report and technique.

The benefits of laparoscopic surgery over open abdominal surgery have been well documented. Efforts continue for development of strategies that further reduce the size of abdominal incisions and the number of trocars used. Laparoendoscopic single-site surgery (LESS) is a promising approach that can further enhance cosmetic satisfaction and reduce the risks of laparoscopic surgery. Loss of triangulation, instrument crowding and clashing, poor visualization, and ergonomic problems are the most challenging issues associated with the use of LESS. The combination of LESS and the robotic system seems to be a promising choice to overcome the technical difficulties of LESS. The da Vinci Single-Site Surgical Platform is a novel semi-rigid robotic operating system. We present our initial clinical experience with robotic-assisted single-incision transumbilical total hysterectomy using the novel da Vinci Single-Site Surgical Platform.

Learning Curve Analysis of Intracorporeal Cuff Suturing During Robotic Single-Site Total Hysterectomy

STUDY OBJECTIVE To analyze the learning curve of intracorporeal cuff suturing during robotic single-site total hysterectomy. DESIGN Retrospective study (Canadian Task Force classification II-1). SETTING University hospital. PATIENTS Twenty-four patients with benign indications for hysterectomy. INTERVENTIONS Twenty-four patients who underwent robotic single-site total hysterectomy to treat benign indications were included in the study. Surgical procedures were performed by a single surgeon with extensive experience in laparoscopy, using the single-site platform of the da Vinci Surgical System. All vaginal cuffs were closed intracorporeally using semi-rigid single-site instruments. MEASUREMENTS AND MAIN RESULTS An exponential learning curve technique was used to analyze the learning curve. The overall mean (SD) vaginal cuff closure time was 23.2 (7) minutes. Learning curve analysis revealed a decrease in vaginal closure time after 14 procedures. CONCLUSIONS An experienced robotic surgeon requires approximately 14 procedures to achieve proficiency in intracorporeal cuff suturing during robotic single-site total hysterectomy. Novel instruments that create perfect triangulation are needed to overcome the current challenges of suturing and to shorten operative time.

Laparoscopic virtual reality simulator and box trainer in gynecology

To investigate whether a virtual reality simulator (LapSim) and traditional box trainer are effective tools for the acquisition of basic laparoscopic skills, and whether the LapSim is superior to the box trainer in surgical education.

Uterine rupture in pregnancy after robotic myomectomy

Uterine rupture in pregnancy is a rare and often catastrophic complication with a high incidence of fetal and maternal morbidity. A gravida 2 para 1 woman aged 40 years who was 33-34 weeks pregnant presented to our clinic with serious abdominal pain, nausea and vomiting that had begun 6 hours previously. Her past surgical history included a robotic myomectomy 2 years ago in our unit. Obstetric ultrasonography revealed a 33-week fetus without a heartbeat whereupon she underwent emergency laparotomy and we found a 4 cm rupture on the anterior wall of the uterus. Uterine rupture should always be kept in mind, especially in patients with history of uterine surgery.

Vaginal cuff dehiscence with bowel evisceration after robotic hysterectomy

Vaginal cuff dehisence with bowel evisceration after hysterectomy is a very rare complication. However, the incidance of this complication appears to be increased with the widely used techniques of laparoscopic surgery especially with robotic hysterectomy. In this case report we aimed to evaluate the risk factors and treatment methods for this complication.

A Safe, Effective, and Alternative Technique for Fascial Port Site Closure

Background and Objectives: Fascial closure of the 10-mm and 12-mm port sites is mostly recommended to avoid port site incisional herniation. However, it is often difficult and time-consuming. The aim of this study is to describe a novel technique for fascial closure of laparoscopic port sites. Methods: The fascial closure was performed using straight needle and standard surgical instruments under the laparoscopic visualization in 100 patients. The time duration of the closure, intraoperative and postoperative complications, and patient characteristics were recorded. All patients were examined at postoperative third and sixth months. Results: Intraoperative or postoperative complications were not observed. The mean time for fascial closure was 90 seconds. No port site hernia was encountered at the third month and sixth month postoperative examinations. Discussion: The present technique is safe, effective, easy, and does not require any special instruments. Our technique should be kept in mind during fascial closure of the laparoscopic port sites.