ROBOTIC-ASSISTED SURGERY PROCEDURES
Robotic surgery or robotic-assisted surgery is the most advanced surgical technology and being performed at various advanced medical centers in Turkey and especially in the U.S.A. Robotic-assisted surgery technology is coming to the forefront with its advantages for both patients and surgeons. Today, it is one of the surgical methods with great success rate particularly for fighting against cancer.
Main advantages of robotic-assisted surgery for patients are as follows: Better cosmetic outcomes thanks to small incisions (< 1cm), less blood loss and therefore less need for blood transfusion during the operation, less pain and therefore less need for painkiller, less complication, shorter length of hospital stay and a more rapid resumption of daily-life activities.
Robotic-assisted surgery also provides following advantages for surgeons; 3-Dimensional imaging with depth perception, 570 degrees freedom of movement on seven axes with EndoWrist® technology, opportunity to control three separate devices and three separate arms together, suppression of hand tremor and ability to reach body areas that are difficult to access with open surgery, through the robotic arms. As surgeons can work in a seated position, this system offers optimal ergonomics to them, makes them feel less tired, boosts their concentration levels and allows them to perform the surgeries for longer hours.
Our team holds many courses regarding endoscopic, laparoscopic and robotic-assisted surgery at Koç University Hospital and at RMK AIMES training center (Rahmi M. Koç Academy of Interventional Medicine, Education & Simulation) of our hospital.
At Koç University Hospital, two new state-of the –art da Vinci Xi surgical robots are used by our general surgeons in treatment of below mentioned diseases;
The use of robotic technology in the field of general surgery:
- Digestive System Surgery
- Achalasia (esophageal motility disorder)
- Gastro-esophageal Reflux Disease (GERD)
- Hiatal Hernia
- Esophageal cancer
- Gastric tumors
- Colon diseases
- Rectal prolapse and pelvic floor diseases
- Bariatric surgery (obesity surgery)
- Liver, pancreas and bile duct Surgery
- Gall bladder diseases
- Excision of cancerous tumor that metastasize to the liver (metastasectomy)
- Resection of a portion of the liver (hepatectomy)
- Pancreaticoduodenectomy (Whipple procedure)
- Distal pancreatectomy
- Pancreatic enucleation
- Endocrine Surgery
Digestive System Surgery
Achalasia (Esophageal motility disorder)
Achalasia is a digestive system disease that is characterized by impaired relaxation of the sphincter consisting of the muscle layer between the esophagus and the stomach, resulting in the buildup of food in the esophagus. Normally, the lower esophageal sphincter opens up during swallowing. In individuals with achalasia, it fails to open up secondary to nerve injury or impairment of the sphincter. The condition can be managed through POEM (Per-Oral Endoscopic Myotomy). If it is not possible to perform endoscopic treatment, it can be treated through robotic-assisted surgery. With the help of 3-dimensional imaging and robotic arms’ superior movement capacity, the operation can be performed in a more sensitive and flexible manner compared to the conventional methods. The condition can be managed through POEM (Per-Oral Endoscopic Myotomy) which is recently popular. If it is not possible to perform endoscopic treatment, it can be treated through robotic-assisted surgery. During robotic assisted surgery, the longitudinal and circular muscle fibers at junction of esophagus and stomach are properly dissected and the dissection is extended up to 3 cm onto the stomach (Heller Myotomy). After the muscle fibers are cut, the gastric fundus is wrapped around junction of esophagus and stomach to prevent the development of gastroesophageal reflux (Dor Fundoplication). Thanks to high-resolution 3-dimensional imaging and robotic arms’ superior movement capability, the operation is carried out in a safer and more sensitive and flexible manner compared to the conventional methods.
Gastro-esophageal Reflux Disease (GERD)
The term, GERD, is used to describe conditions caused by gastric acid flowing back into the esophagus secondary to a loose sphincter located between the stomach and esophagus. Surgery is recommended if complaints persist despite lifestyle modifications or medication therapy. During robotic assisted surgery, the gastric fundus is wrapped around the esophagogastric junction (fundoplication). Thanks to high-resolution 3-dimensional imaging and robotic arms’ superior movement capability, the operation is carried out in a safer and more sensitive and flexible manner compared to the conventional methods.
Hiatal Hernia
It is a condition where a portion of the stomach or the entire stomach bulges up into the thorax through an opening (esophageal hiatus) in the diaphragm, the flat muscle that separates the thoracic cavity from the abdominal cavity. Surgery is recommended if complaints persist despite lifestyle modifications or medication therapy. During robotic assisted surgery, the gastric fundus is gently wrapped around the esophagogastric junction at 270° or 360° (fundoplication). Also, the opening (hiatus) between the abdominal cavity and chest is narrowed using primary sutures and/or graft during hiatal hernia surgeries. Thanks to Da Vinci Xi surgical robots’ superior movement capability and the opportunity to control three separate devices and three separate arms together, such surgeries are performed safely, smoothly and rapidly.
Esophageal cancer
In surgical treatment of esophageal cancer, the entire esophagus and a portion of the stomach is excised together with surrounding lymph nodes. As both the abdominal cavity and chest are intervened, the operation is very complicated and challenging. However, such difficulties can easily be overcome with numerous features of robotic surgery system. High-resolution 3-dimensional imaging enables the anatomical structures (neighboring organs, vessels, nerves, lymphatic canals and lymph nodes) and other relevant sites to be identified well, and thus the surgery can be performed safely. By means of these properties, the surgery is carried out in a safer and more sensitive manner by sparing vital vessels and nerves in the chest. Besides, resection and reconstruction can be done safely and rapidly in the abdomen (intracorporeal) through 540 degrees freedom of movement on seven axes with EndoWrist® technology. Intracorporeal interventions to be made during the operation are associated with less postoperative pain, less incision site infection, less complication and shorter hospital stay. Moreover, by virtue of indocyanine green injected during the operation and Firefly® technology of da Vinci surgical system, blood supply in the relevant areas where anastomosis is planned to be done is checked, anastomosis is done between the areas with higher blood supply and anastomotic leaks are prevented significantly.
Gastric tumors
Benign and malignant gastric tumors can be treated with robotic assisted surgery alone or in combination with endoscopy. This combination that is applicable at a limited number of centers in the world is successfully applied at Koç University Hospital. In surgical treatment of gastric cancer, a portion of the stomach or the entire stomach and a portion of the esophagus are excised together with surrounding lymph nodes. In some cases, the surgery is very complicated and challenging to perform as it is necessary to reach the terminal portion of the esophagus in the chest through abdominal cavity. However, such difficulties can easily be overcome with numerous features of robotic surgery system. High-resolution 3-dimensional imaging enables the anatomical structures (neighboring organs, vessels, nerves, lymphatic canals and lymph nodes) and other relevant sites to be identified well, and thus the dissection can be performed safely. By means of these properties, wide lymph node dissection can be performed in a safer and more sensitive manner particularly for gastric cancer.
Besides, resection and reconstruction can be done safely and rapidly in the abdomen (intracorporeal) through 540 degrees freedom of movement on seven axes with EndoWrist® technology. Intracorporeal interventions to be made during the operation are associated with less postoperative pain, less incision site infection, less complication and shorter hospital stay. Moreover, by virtue of indocyanine green injected during the operation and Firefly® technology of da Vinci surgical system, blood supply in the relevant areas where anastomosis is planned to be done is checked, anastomosis is done between the areas with higher blood supply and anastomotic leaks are prevented significantly.
Colonic diseases
The diseased portion of the colon (tumor, inflammation or diverticulitis) is removed with colectomy. The decision regarding to what extent the colonic segment can be removed is made considering the location and size of the tumor. Then, both ends are connected (anastomosis) using sutures and staplers. The removal of the right side of the colon is called right hemicolectomy, while the removal of the left side of the colon is called left hemicolectomy, the removal of the sigmoid colon is called anterior resection and the near complete removal or complete removal of the colon is called subtotal or total colectomy. It is highly important to excise neighboring lymph nodes or lymph nodes on the common blood vessels, however, it is a challenging procedure. However, such difficulties can easily be overcome with numerous features of robotic surgery system. High-resolution 3-dimensional imaging enables the anatomical structures (neighboring organs, vessels, nerves, lymphatic canals and lymph nodes) and other relevant sites to be identified well, and thus the surgery can be performed safely. By means of these properties, D3 dissection is done in a safer and more sensitive manner particularly during the removal of the right side of the colon. Besides, resection and reconstruction can be done safely and rapidly in the abdomen (intracorporeal) through 540 degrees freedom of movement on seven axes with EndoWrist® technology. Intracorporeal interventions to be made during the operation are associated with less postoperative pain, less incision site infection, less complication and shorter hospital stay. Moreover, by virtue of indocyanine green injected during the operation and Firefly® technology of da Vinci surgical system, blood supply in the relevant areas where anastomosis is planned to be done is checked, anastomosis is done between the areas with higher blood supply and anastomotic leaks and infections are prevented significantly.
In certain diseases like familial adenomatous polyposis and ulcerative colitis, it is necessary to surgically remove the entire colon and rectum-the terminal part of the colon-, and in this case, a reservoir should be constructed from the small intestine and attached to the location of the rectum. This artificial reservoir is called pouch. Many studies indicate that the long-term results of pouch surgery are better owing to high-resolution 3-dimensional imaging of da Vinci surgical system and robotic arms’ superior movement capability.
Rectal cancer
The rectum is the most distal segment of the colon. In rectal cancer, the decision regarding to what extent the rectal segment can be removed is made considering the location and size of the tumor. Then, both ends are connected using staplers. The near complete removal of the rectum is called low anterior resection, while the complete removal of the rectum is called abdominoperineal resection (Miles Surgery). It is highly important to excise neighboring lymph nodes or lymph nodes on the common blood vessels; however, it is a challenging procedure. Furthermore, for patients with large tumor at the distal end of the rectum, overweight patients and patients with deeper and narrower pelvis, the surgery becomes more complicated and difficult to perform for the surgeon. However, such difficulties can easily be overcome with numerous features of robotic surgery system. High-resolution 3-dimensional imaging enables the anatomical structures (neighboring organs, vessels, nerves, lymphatic canals and lymph nodes) and other relevant sites to be identified well, and thus the surgery can be performed safely. Thanks to these properties, the nerves can be easily visualized and spared particularly during pelvic dissection. Thus, postoperative voiding dysfunction, erectile dysfunction and vaginal dryness are infrequent. Besides, resection and reconstruction can be done safely and rapidly in the abdomen (intracorporeal) through 540 degrees freedom of movement on seven axes with EndoWrist® technology.
Intracorporeal interventions to be made during the operation are associated with less postoperative pain, less incision site infection, less complication and shorter hospital stay. Moreover, by virtue of indocyanine green injected during the operation and Firefly® technology of da Vinci surgical system, blood supply in the relevant areas where anastomosis is planned to be done is checked, anastomosis is done between the areas with higher blood supply and anastomotic leaks and intraabdominal infection are prevented significantly.
Rectal prolapse and pelvic floor diseases
Rectal prolapse is when the rectum-the terminal portion of the colon-protrudes from the anus. Surgery is the main treatment option for rectal prolapse. However, a wide range of surgical techniques can be applied for this condition. It is necessary to prefer the most appropriate technique considering the patients’ complaints. Unlike conventional abdominal surgery, dissection, suturing, graft placement and fixation are performed easily, rapidly and safely during robotic assisted rectopexy thanks to many advantages of robotic surgery explained above.
Bariatric surgery (obesity surgery)
In morbidly obese patients, the presence of excess fat tissue makes the operation difficult. Among bariatric surgeries performed with Da Vinci, sleeve gastrectomy and gastric by-pass surgeries are the most commonly performed ones. This method aims to reduce food absorption by both reducing the size of the stomach and bypassing a part of the intestines. For patients with excess fat tissue, difficulties to be encountered during bariatric surgeries can easily be overcome with robotic surgical systems.
Liver, Pancreas and Bile Duct Surgery
Gall bladder diseases
Cholecystectomy (surgical removal of the gallbladder) is performed particularly for the diseases caused by gallbladder stones or for gallbladder polyps. Since the first robotic cholecystectomy was performed, studies made within the last 20 years have shown that robotic-assisted gallbladder surgery is just as safe as laparoscopic gallbladder surgery. Compared to open surgery, robotic-assisted surgery results in minimal postoperative pain, shorter hospital stay and a smaller scar similar to laparoscopic gallbladder surgery. Different from laparoscopic technique, the advantages of robotic surgery are clear visualization with three dimensional imaging and easier access to the relevant tissues through advanced movement capability of robotic surgical instruments. Also, surgical robot allows gallbladder surgery to be performed through single umbilical incision.
Excision of cancerous tumor that metastasize to the liver (metastasectomy)
Metastasis means the spread of cancer from its site of origin (organ) to another part of the body. When metastasis occurs in the liver, this condition is called hepatic metastasis. Metastases originating from the colon, stomach, pancreas, bile ducts, small intestine and breast cancers are common as well. Robotic surgery allows even the smallest tissues and vessels to be divided and sealed with fixed camera system and advanced instruments and the intact hepatic tissue to be left even in case of deep-seated masses in the liver.
Excision of a portion of the liver (hepatectomy)
Hepatectomy (the removal of the one half of the liver) is performed for cancers located in the right or left half of the liver, gallbladder cancer or the presence of metastases in multiple foci. With the help of technical opportunities of robotic surgery, acceptable oncologic outcomes can be obtained and more functioning hepatic tissue can be left. Robotic hepatectomy brings about considerable advantages such as less peroperative blood loss, shorter hospital stay in postoperative period, less need for painkiller and less complication. Today, robotic surgical system is utilized for some of living donor liver transplants.
Pancreaticoduodenectomy (Whipple procedure)
This surgery is applicable to patients with pancreatic head cancer, duodenal cancer or cancer involving the terminal portion of the bile duct. Robotic pancreaticoduodenectomy is one of the most complicated minimally invasive surgeries. Positive outcomes can be obtained when this surgery is performed by experienced teams at well equipped centers for suitable patients (with local invasion). In case above specified preconditions are not met, operative mortality increases, as also indicated by LEOPARD-2 trial dated 2020.
Compared to other conventional surgical methods, the main advantages of robotic pancreas surgery are less blood loss, shorter hospital stay and oncologically acceptable, more successful dissection. Different from laparoscopic technique, the advantages of robotic surgery are clear visualization with three dimensional imaging and easier access to the deeper tissues through advanced movement capability of robotic surgical instruments.
Distal pancreatectomy
This surgery is performed mostly for benign cancers located at the distal segment of the pancreas. Advanced ergonomics, suppression of tremor and motion scaling provided by 360-degree movement of the surgical instruments and advanced 3-dimensional imaging increase the success of this surgery. In surgeries that require protection of surrounding organs like distal pancreatectomy, high success rates are achieved as the tumor is excised without harming healthy tissues thanks to robotic surgery. LEOPARD trial conducted on this issue indicates that minimally invasive distal pancreatectomy is a safe and effective technique.
Pancreatic enucleation
Pancreatic enuclation is a method where only the tumor is excised without harming non-tumoral pancreatic tissue. This surgical method can be applied particularly for the pancreatic cysts that cannot be differentiated as benign or malignant and for pancreatic neuroendocrine tumors in suitable patients. When performed for suitable patients, it reduces the risk of many complications and the rest healthy pancreatic tissue allows patients to continue their lives without any deficiency, as indicated by relevant studies. If pancreatic enucleation is combined with robotic technique, it provides advantages like shorter operative duration, less blood loss, less postoperative pain and shorter hospital stay, compared to conventional surgery.
Endocrine Surgery
Adrenal gland diseases
Today, in surgical treatment of adrenal gland diseases, minimally invasive techniques (laparoscopic and robotic surgery) are applied safely at experienced centers in developed countries. As proven in the literature, minimally invasive techniques bring about less postoperative pain, less need for analgesic agents, shorter hospital stay, shorter operative duration and better cosmetic outcomes, compared to open surgery. Statistics show that 3-dimensional imaging and precise movement of the surgical instruments are useful for deep seated tumors -considering adrenal glands’ narrow anatomical location-, large tumors (particularly 5 cm and above) and tumors adhered to surrounding organs. At out hospital, robotic adrenal gland surgery can be performed safely for suitable patients.
LAPAROSCOPIC PROCEDURES
Laparoscopic surgery is the most advanced surgical technology succeeded following the robotic assisted surgery and has been performed at various advanced medical centers in Turkey and especially in the U.S.A for four centuries. Laparoscopic surgery is coming to the forefront with its advantages for patients. Today, it is the most successful surgical method all around the world particularly for fighting against cancer.
Main advantages of laparoscopic surgery for patients are as follows: Better cosmetic outcomes thanks to small incisions (< 1cm), less blood loss and therefore less need for blood transfusion during the operation, less pain and therefore less need for painkiller, less complication, shorter length of hospital stay and a more rapid resumption of daily-life activities. Also, it is shown that laparoscopic surgery provides lower surgery cost and shorter operative duration compared to robotic assisted surgery.
Laparoscopic surgery provides following advantages for surgeons; tactile sensation, which is not possible in robotic assisted surgery, and opportunity to reach body areas that are difficult to access in open surgery, with laparoscopic devices under high-resolution imaging.
Our team holds many courses regarding endoscopic, laparoscopic and robotic-assisted surgery at Koç University Hospital and at RMK AIMES training center (Rahmi M. Koç Academy of Interventional Medicine, Education & Simulation) of our hospital.
At Koç University Hospital, ten new state-of the –art Karl Storz® laparoscopes (KARL STORZ Endoskop, Tuttlingen, Germany) are used by our general surgeons in treatment of below mentioned diseases;
The use of laparoscopic surgery in the field of general surgery:
- Digestive System Surgery
- Achalasia (esophageal motility disorder)
- Gastro-esophageal Reflux Disease (GERD)
- Hiatal Hernia
- Esophageal cancer
- Gastric tumors
- Colonic diseases
- Rectal prolapse and pelvic floor diseases
- Bariatric surgery (obesity surgery)
- Liver, pancreas and bile duct SurgeryCholecystectomy
- Hepatic metastasectomy
- Hepatectomy, Pancreaticoduodenectomy (Whipple procedure)
- Distal pancreatectomy
- Pancreatic enucleation
- Endocrine Surgery
- Thyroid and parathyroid gland surgery
- Adrenal gland surgery
Digestive System Surgery
Achalasia (esophageal motility disorder)
Achalasia is a digestive system disease that is characterized by impaired relaxation of the sphincter consisting of the muscle layer between the esophagus and the stomach, resulting in the buildup of food in the esophagus. Normally, the lower esophageal sphincter opens up during swallowing. In individuals with achalasia, it fails to open up secondary to nerve injury or impairment of the sphincter. The condition can be managed through POEM (Per-Oral Endoscopic Myotomy). If it is not possible to perform endoscopic treatment, it can be treated through laparoscopic surgery. The condition can be managed through POEM (Per-Oral Endoscopic Myotomy) which is recently popular. If it is not possible to perform endoscopic treatment, it can be treated through laparoscopic surgery. During laparoscopic surgery, the longitudinal and circular muscle fibers at junction of esophagus and stomach are properly dissected and the dissection is extended up to 3 cm onto the stomach (Heller Myotomy). After the muscle fibers are cut, the gastric fundus is wrapped around junction of esophagus and stomach to prevent the development of gastroesophageal reflux (Dor Fundoplication). Thanks to high-resolution imaging and laparoscopic surgical devices, the operation is carried out in a safer and more sensitive manner compared to the conventional methods.
Gastro-esophageal Reflux Disease (GERD)
The term, GERD, is used to describe conditions caused by gastric acid flowing back into the esophagus secondary to a loose sphincter located between the stomach and esophagus. Surgery is recommended if complaints persist despite lifestyle modifications or medication therapy. During laparoscopic surgery, the gastric fundus is wrapped around the esophagogastric junction (fundoplication). Thanks to high-resolution imaging and laparoscopic surgical devices, the operation is carried out in a safer and more sensitive manner compared to the conventional methods.
Hiatal Hernia
It is a condition where a portion of the stomach or the entire stomach bulges up into the thorax through an opening (esophageal hiatus) in the diaphragm, the flat muscle that separates the thoracic cavity from the abdominal cavity. Surgery is recommended if complaints persist despite lifestyle modifications or medication therapy. During laparoscopic surgery, the gastric fundus is gently wrapped around the esophagogastric junction at 270° or 360° (fundoplication). Also, the opening (hiatus) between the abdominal cavity and chest is narrowed using primary sutures and/or graft during hiatal hernia surgeries. Thanks to high-resolution imaging and laparoscopic surgical devices, the operation is carried out in a safer and more sensitive manner compared to the conventional methods.
Esophageal cancer
In surgical treatment of esophageal cancer, the entire esophagus and a portion of the stomach is excised together with surrounding lymph nodes. As both the abdominal cavity and chest are intervened, the operation is very complicated and challenging. However, such difficulties can easily be overcome with numerous features of laparoscopic surgery systems. High-resolution imaging enables the anatomical structures (neighboring organs, vessels, nerves, lymphatic canals and lymph nodes) and other relevant sites to be identified well, and thus the surgery can be performed safely. By means of these properties, the surgery is carried out in a safer and more sensitive manner by sparing vital vessels and nerves in the chest. Moreover, by virtue of indocyanine green injected during the operation and laparoscopic fluorescence platform -Karl Storz® laparoscope (KARL STORZ Endoscope, Tuttlingen, Germany), blood supply of relevant areas where anastomosis is planned to be done is checked, anastomosis is done between areas with higher blood supply and anastomotic leaks are prevented significantly.
Gastric tumors
Benign and malignant gastric tumors can be treated with laparoscopic surgery alone or in combination with endoscopy. This combination that is applicable at a limited number of centers in the world is successfully applied at Koç University Hospital. In surgical treatment of gastric cancer, a portion of the stomach or the entire stomach and a portion of the esophagus are excised together with surrounding lymph nodes. In some cases, the surgery is very complicated and challenging to perform as it is necessary to reach the terminal portion of the esophagus in the chest through abdominal cavity. However, such difficulties can easily be overcome with numerous features of laparoscopic surgery systems. High-resolution imaging enables the anatomical structures (neighboring organs, vessels, nerves, lymphatic canals and lymph nodes) and other relevant sites to be identified well, and thus the dissection can be performed safely. By means of these properties, wide lymph node dissection can be performed in a safer and more sensitive manner particularly for gastric cancer. Moreover, with indocyanine green injected during the operation and laparoscopic fluorescence platform -Karl Storz® laparoscope (KARL STORZ Endoscope, Tuttlingen, Germany), blood supply of relevant areas where anastomosis is planned to be done is checked, anastomosis is done between areas with higher blood supply and anastomotic leaks are prevented significantly.
Colonic diseases
The diseased portion of the colon (tumor, inflammation or diverticulitis) is removed with colectomy. The decision regarding to what extent the colonic segment can be removed is made considering the location and size of the tumor. Then, both ends are connected (anastomosis) using sutures and staplers. The removal of the right side of the colon is called right hemicolectomy, while the removal of the left side of the colon is called left hemicolectomy, the removal of the sigmoid colon is called anterior resection and the near complete removal or complete removal of the colon is called subtotal or total colectomy. It is highly important to excise neighboring lymph nodes or lymph nodes on the common blood vessels, however, it is a challenging procedure. However, such difficulties can easily be overcome with numerous features of laparoscopic surgery systems. High-resolution imaging enables the anatomical structures (neighboring organs, vessels, nerves, lymphatic canals and lymph nodes) and other relevant sites to be identified well, and thus the operation can be performed safely. By means of these properties, D3 dissection is done in a safer and more sensitive manner particularly during the removal of the right side of the colon. Moreover, with indocyanine green injected during the operation and laparoscopic fluorescence platform -Karl Storz® laparoscope (KARL STORZ Endoscope, Tuttlingen, Germany), blood supply of relevant areas where anastomosis is planned to be done is checked, anastomosis is done between areas with higher blood supply and anastomotic leaks are prevented significantly.
Rectal cancer:
The rectum is the most distal segment of the colon. In rectal cancer, the decision regarding to what extent the rectal segment can be removed is made considering the location and size of the tumor. Then, both ends are reconnected using staplers. The near complete removal of the rectum is called low anterior resection, while the complete removal of the rectum is called abdominoperineal resection (Miles Surgery). It is highly important to excise neighboring lymph nodes or lymph nodes on the common blood vessels; however, it is a challenging procedure. Furthermore, for patients with large tumor at the distal end of the rectum, overweight patients and patients with deeper and narrower pelvis, the surgery becomes more complicated and difficult to perform for the surgeon. However, such difficulties can easily be overcome with numerous features of laparoscopic surgery systems. High-resolution imaging enables the anatomical structures (neighboring organs, vessels, nerves, lymphatic canals and lymph nodes) and other relevant sites to be identified well, and thus the operation can be performed safely. Thanks to these properties, the nerves can be easily visualized and spared particularly during pelvic dissection. Thus, postoperative voiding dysfunction, erectile dysfunction and vaginal dryness are infrequent. Moreover, with indocyanine green injected during the operation and laparoscopic fluorescence platform -Karl Storz® laparoscope (KARL STORZ Endoscope, Tuttlingen, Germany), blood supply of relevant areas where anastomosis is planned to be done is checked, anastomosis is done between areas with higher blood supply and anastomotic leaks are prevented significantly.
Rectal prolapse and pelvic floor diseases
Rectal prolapse is when the rectum-the terminal portion of the colon-protrudes from the anus. Surgery is the main treatment option for rectal prolapse. However, a wide range of surgical techniques can be applied for this condition. It is necessary to prefer the most appropriate technique considering the patients’ complaints. Unlike conventional abdominal surgery, dissection, suturing, graft placement and adaptation are performed easily, rapidly and safely during laparoscopic rectopexy because of thanks to many advantages of laparoscopic surgery mentioned above.
Bariatric surgery (obesity surgery)
In morbidly obese patients, the presence of excess fat tissue makes the operation difficult. Among laparoscopic bariatric surgeries, sleeve gastrectomy and gastric by-pass surgeries are the most commonly performed ones. This method aims to reduce food absorption by both reducing the size of the stomach and bypassing a part of the intestines. For patients with excess fat tissue, difficulties to be encountered during bariatric surgeries can easily be overcome with laparoscopic technique.
Liver, Pancreas and Bile Duct Surgery
Cholecystectomy
Minimally invasive laparoscopic cholecystectomy is a procedure in which the gallbladder is removed from the body through four tiny incisions made on the abdomen with the help of a camera and surgical tools to treat gallbladder diseases. Compared to open cholecystectomy, the main advantages of laparoscopic cholecystectomy are shorter hospital stay, less peroperative blood loss, less postoperative pain, less incision site infections and less postoperative complications like incisional hernia.
Hepatic metastasectomy
Although laparoscopic surgery is rapidly becoming popular in treatment of primary colorectal cancers, laparoscopic metastasectomy did not get such overt attention in treatment of colorectal cancers that metastasize to the liver. However, many clinical trials demonstrate that laparoscopic metastasectomy brings about acceptable oncological surgery outcomes, shorter hospital stay, less incision site infection and less need for analgesic agent in postoperative period, compared to open surgical methods.
Hepatectomy
Today, laparoscopic surgery is commonly used in treatment of benign and malignant hepatic masses in selected patients. Compared to open surgical methods, the main advantages of the procedure are similar oncologic outcomes, less need for blood transfusion, shorter hospital stay and less postoperative complication.
Pancreaticoduodenectomy (Whipple procedure)
This procedure can be performed safely by only experienced surgeons, as it is technically complicated and requires substantial experience. Along with the usual advantages of minimally invasive surgery such as less peroperative blood loss, less pain, shorter hospital stay and returning to work earlier, laparoscopic pancreatoduodenectomy related complications are similar to that of open pancreato-duodenectomy in terms of oncologic safety and general outcomes.
Distal pancreatectomy
Laparoscopic distal pancreatectomy a surgical method that is preferred for benign, premalignant or malignant masses in pancreatic corpus and tail. Compared to open surgery, the most important advantages of this procedure are shorter hospital stay and less postoperative pain. Splenectomy is commonly performed as a part of distal pancreatectomy due to the anatomic location, surgical technique and type of the disease. However, many studies in the literature show that spleen-preserving surgery can be performed if distal pancreatectomy is carried out with laparoscopic technique particularly in benign pancreatic diseases.
Pancreatic enucleation
Enucleation is a parenchyma-preserving pancreatic surgery method. In treatment of small, benign or potentially malignant lesions, this surgical method is preferred to prevent unnecessary pancreatic tissue loss, anastomosis related complications and to protect pancreatic functions remarkably. In the literature, some studies show that enucleation procedure – less invasive compared to major pancreas surgery- can be successfully performed with laparoscopic approach because of its advantages like less postoperative pain, less blood loss, less incision site infections.
Endocrine Surgery
Thyroid and parathyroid gland surgery
Scarless thyroid and parathyroid gland surgery, which is becoming increasingly popular not only in our country but also worldwide, can be safely performed by accessing over the armpit, breast, neck or lip in selected patients. In these patients, it is important to decide the most appropriate and beneficial technique considering radiologic-pathologic results and anatomic structures.
Adrenal gland surgery
At our hospital, laparoscopic surgery is routinely performed for adrenal gland operations. Typically, this type of laparoscopic surgery is performed through 3 to 4 incisions, but it can be successfully performed through a single incision as well in selected patients.