Volkan Tugcu

Objective: To describe The Tugcu Bakirkoy robotic perineal radical prostatectomy and pelvic lymph node dissection technique, and present the results of seven patients. Material and methods: We performed seven robotic perineal radical prostatectomy and pelvic lymph node dissection operation using Da Vinci Xi HD Surgical System (Intuitive Surgical, Inc., Sunnyvale, California, USA) on single Gel-port platform. The operation is completed in 4 stages: stage 1 open perineal dissection and gel port placement, stage 2 robotic perineal radical prostatectomy, stage 3 robotic pelvic lymph node dissection, stage 4 vesico-urethral anastomosis. In addition to describing the operation technique step by step, we aimed to present the perioperative and postoperative findings of the seven patients who underwent The Tugcu Bakirkoy Technique. Results: All operations were successfully completed without any complications in fully the robotic procedure by a single surgeon. Demographic data of the patients were as follows: Mean age (62.1±8 years), mean body mass index (28.2±0.7 kg/m2), mean prostate specific antigen value (10.7±3 ng/mL), and mean prostate volume (64.2±15.3 cc). Mean operative time (184.1±20.2 mins), blood loss (64.2±15.3 cc), hospitalization time (2.1±0.6 days), and time to withdrawal of the urethral catheter (7.8±0.8 days) were also estimated. According to the pathology results, lymph node metastasis was detected in 3 patients while the surgical margin was positive in one. Conclusion: We demonstrated for the first time that a new The Tugcu Bakirkoy robotic perineal radical prostatectomy technique which was previously tested in a cadaveric model, can be safely applied for the first time in vivo, and presented our results. On the basis of this, for problems that can not be overcome by traditional methods, this method is a good alternative as a way out. In this regard, it is necessary to carry out advanced studies so that this method can be applied to daily practice. Cite this article as: Tuğcu V, Akça O, Şimşek A, Yiğitbaşı İ, Yenice MG, Şahin S, et al. Robotic perineal radical prostatectomy and robotic pelvic lymph node dissection via a perineal approach: The Tugcu Bakirkoy Technique. Turk J Urol 2018; 44(2): 114-8.

Objective: To evaluate a single surgeon oncological and functional outcomes of laparoscopic partial nephrectomy (LPN) compared to robotic partial nephrectomy (RPN) for pT1a renal tumours. Materials and methods: Between 2006 and 2016, a retrospective review of 42 patients who underwent LPN (n = 20) or RPN (n = 22) by same surgeon was performed. Patients were matched for gender, age, body mass index (BMI), American Society of Anaesthesiologists (ASA) score, tumour side, RENAL and PADUA scores, peri-operative and post-operative outcomes. Results: There was no significant differences between the two groups with respect to patient gender, age, BMI, ASA score, tumours side, RENAL and PADUA scores. Mean operative time for RPN was 176 vs. 227 minutes for LPN (p = 0.001). Warm ischemia time was similar in both groups (p = 0.58). Estimated blood loss (EBL) was higher in the LPN. There was no significant difference with preoperative and postoperative creatinine and percent change in eGFR levels. Only one case in LPN had positive surgical margin. Conclusions: RPN is a developing procedure, and technically feasible and safe for small-size renal tumours. Moreover RPN is a comparable and alternative operation to LPN, providing equivalent oncological and functional outcomes, as well as saving more healthy marginal tissue and easier and faster suturing.

Objective: Minimally invasive techniques are increasingly evolving and preferred to reduce surgical induced morbidity and mortality and minimize the challenges of surgical techniques. Especially radical perineal prostatectomy (RPP) includes some challenges like working in a deep and narrow space and challenging ergonomics for the surgeons. Because of these issues open RPP is still performed in experienced centers. In order to reduce these difficulties, robot- assisted radical perineal prostatectomy (r-RPP) is developed. In this study, we report our first clinical results for r-RPP. Material and methods: Between November 2016 and February 2017, 15 patients underwent r-RPP in our center. Multiparametric magnetic resonance imaging was performed for all patients to exclude locally advanced disease. The patients with chronic obstructive pulmonary disease and locally advanced prostate cancer were not chosen for r-RPP method. The patient was positioned in the exaggerated lithotomy with 15 degrees of Trendelenburg position. After incision and dissection of subcutaneous tissue, dissection was advanced to the margin of posterior recto-urethral muscle fibers. Then a GelPOINT® device was placed and robotic system was docked. Results: The mean age of the patients was 60.2±7.8 years. The mean body mass index of the patients was 28.8±1.9 kg/m2. Four patients had previous major abdominal surgeries. Preoperative mean prostate specific antigen value was 7.3±2.4 ng/mL. The mean prostate volume was 40.8±12.4 cc. Mean perineal dissection time was 60±10.1 minutes. Mean console time and total operation time was 95±11.3 and 167±37.4 minutes, respectively. The mean time of postoperative catheterization was 8.3±1.7 days. Early continence rate was 40% after urethral catheter removal and at 3rd month of the surgery mean continence rate was 94% for all patients. Conclusion: We demonstrate that r-RPP is a feasible and efficient method. But still this method needs for further studies in this area. Cite this article as: Tuğcu V, Akça O, Şimşek A, Yiğitbaşı İ, Şahin S, Taşçı Aİ. Robotic assisted radical perineal prostatectomy: first experience of 15 cases. Turk J Urol 2017; 43(4): 476-83

Objective: To present our experience with laparoscopic donor nephrectomy (LDN), our complications and management modalities. Material and methods: Fifty-one transperitoneal LDNs performed in our clinic between the years 2011, and 2015, were evaluated retrospectively. Demographic characteristics of the patients, operative and postoperative data and complications were evaluated. Results: Nineteen female and 32 male patients with ages ranging from 24 to 65 years underwent left- (n=44), and right-sided (n=7) LDNs. Six patients had two, and one patient three renal arteries. Mean operation time was 115±11 (min-max: 90-150) minutes, and mean warm ischemia time 111±9 (min- max: 90-140 sec) seconds. Mean hospital stay was found to be 2.5±0.5 days. No patient needed to switch to open surgery. In one patient, lumbar vein was ruptured, and hemostatic control was achieved laparoscopically. Postoperative paralytic ileus developed in two patients. Three patients had postoperative atelectasis, and a febrile (38.1oC) episode. Conclusion: LDN is a minimally invasive method with advantages of short hospital stay, less analgesic requirement, and better cosmetic results. However it should be performed by surgeons with advanced laparoscopic experience.

Objectives Paraoxonase-1 (PON1) is a high-density lipoprotein-associated enzyme implicated in the pathogenesis of atherosclerosis by protecting lipoproteins against peroxidation. PON1 has two genetic polymorphisms both due to amino acid substitution, one involving glutamine and arginine at position 192 and the other leucine and methionine at position 55. Recent reports suggest that nephrolithiasis and atherosclerosis share a number of risk factors. Our study aimed to compare the effects of PON1 192, PON1 55 polymorphisms, and PON1 activity in patients with urolithiasis and controls. Materials and methods PON1’s arylesterase/paraoxonase activities and phenotype were determined in 158 stone forming cases (Group 1) and 138 non-stone forming controls (Group 2). The PON1 192 and PON1 55 polymorphisms were studied by polymerase chain reaction/restriction fragment length polymorphism. Results Paraoxonase activity was significantly lower in Group 1 than Group 2 (112 ± 31.8 vs. 208 ± 53.1 IU/L) (p < 0.001). The PON1 L55M polymorphism was significantly higher in Group 1. The “M” allele coding for PON1 was higher in Group 1 (p < 0.001). PON1 192 RR homozygotes had significantly higher PON1 activity than QR and QQ genotypes among all the patients (p < 0.001). Conclusion The results of our study demonstrate that the PON1 55 gene “M” allele is associated with renal stone disease. Individuals possessing the “M” allele have a higher incidence of urolithiasis. The results of this study provide genetic evidence that the PON1 gene may play a role in stone formation. PON1 genotype determination may provide a tool to identify individuals who are at risk of urolithiasis.

Nerve-sparing radical prostatectomies provide excellent control of cancer, but the recovery of continence and sexual function are uncertain. We report the operative details and surgical techniques of a robot-assisted radical prostatectomy (RARP) experiences for organ confined prostate cancer. Between the years of 2009 and 2012, 68 patients with clinically localized prostate cancer underwent fascia-sparing intrafascial nerve-sparing robot-assisted radical prostatectomy and anatomic vesicourethral anastomosis. None of the patients were incontinent. 48 of them had an IIEF-5 potency score equal or greater than 22, without receiving phosphodiesterase-5 inhibitors. Our techniques included preservation of the bladder neck, preservation of the endopelvic fascia and puboprostatic ligaments, a nerve-sparing intrafascial approach, selective suturing of the dorsal venous complex, and anterior and posterior reconstruction. We evaluated the patients at the 1st, 3rd, 6th, and 12th postoperative months to determine if these techniques are correlated with early recovery of urinary continence and potency. The mean operation time was 258.2±78.5 minutes, and the mean estimated blood loss was 111.2±22.9 cc during the operation. A nerve-sparing procedure was performed bilaterally in 62 (91.2 %) cases and unilaterally in 6 (8.8%) cases. The mean drain extraction time was 2.3±0.9 days, and the mean hospital stay was 3.4±1.1 days. The catheter was removed on postoperative day 9.9±0.9. The surgical margin was positive in 10 (14.7%) patients. The continence rates at 1, 3, 6, and 12 months were 74.2%, 76.9%, 80.6%, and 95.6%, respectively. During the same period, among the patients without ED, the potency rates were 29.4%, 38.2%, 54.1%, and 75%, respectively All operations were completed successfully, and there were no major complications. A more comprehensive approach for reporting prostate cancer surgery outcomes is needed. Our study findings suggest that fascia-sparing techniques positively influence the early recovery of urinary continence. However, randomized controlled trials with large samples are needed.

Osteopontin (OPN) is one of the urinary proteins with an important role in stone formation. Recently, OPN Ala250 (rs1126616) polymorphism and other single nucleotide polymorphisms (SNPs) have been studied to define their role in urolithiasis. This study was conducted to examine the impact of OPN Ala250 polymorphism on the risk of stone formation and their association with serum OPN levels. OPN Ala250 polymorphism was investigated in 127 urolithiasis patients and 92 healthy controls. Stones were analyzed for their chemical composition by using X-Ray diffraction method. Genomic DNA was isolated from peripheral blood leucocytes. The study groups were genotyped by PCR-RFLP and serum OPN levels were measured by ELISA. There was a significant difference between urolithiasis patients and controls concerning genotype and allele frequencies of OPN Ala250 (p < 0.05). Separate analysis by BMI greater or less than 25 kg/m² showed that the presence of one mutant T-allele was more frequent in patients with higher BMI than patients with BMI less than 25 kg/m² (p < 0.05). Serum OPN concentrations were two-fold higher in the control group compared to urolithiasis patients (p < 0.05). But the mean serum levels did not show any significant difference between OPN Ala250 genotypes in both groups. Moreover, we found an association between higher BMI and stone formation. Our findings suggest that OPN Ala250 polymorphism is associated with the correlation between weight gain and urolithiasis. However, the correlation between urolithiasis and obesity needs to be further studied in larger cohorts.