Three-dimensional technology facilitates surgical performance of novice laparoscopy surgeons: a quantitative assessment on a porcine kidney model

Objective To determine whether the use of 3-dimensional (3D) imaging translates into a better surgical performance of naïve urologic laparoscopic surgeons during pyeloplasty (PY) and partial nephrectomy (PN) procedures. Materials and Methods Eighteen surgeons without any previous laparoscopic experience were randomly assigned to perform PY and PN in a porcine model using initially 2-dimensional (2D) and 3D laparoscopy. A surgical performance score was rated by an "expert" tutor through a modified 5-item global rating scale contemplating operative field view, bimanual dexterity, efficiency, tissue handling, and autonomy. Overall surgical time, complications, subjective perception of participating surgeons, and inconveniences related to the 3D vision were recorded. Results No difference in terms if operative time was found between 2D or 3D laparoscopy for both the PY (P =.51) and the PN (P =.28) procedures. A better rate in terms of surgical performance score was noted by the tutors when the study participants were using 3D vs 2D, for both PY (3.6 [0.8] vs 3.0 [0.4]; P =.034) and PN (3.6 [0.51] vs 3.15 [0.63]; P =.001). No complications occurred in any of the procedures. Most (77.2%) of the participating na??ve laparoscopic surgeons had the perception that 3D laparoscopy was overall easier than 2D. Headache (18.1%), nausea (18.1%), and visual disturbance (18.1%) were the most common issues reported by the surgeons during 3D procedures. Conclusion Despite the absence of translation in a shorter operative time, the use of 3D technology seems to facilitate the surgical performance of naive surgeons during laparoscopic kidney procedures on a porcine model

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Libidosu azaltılmış kadınlar: düşük androjen seviyeleri ile kadın seksüel fonksiyon indeksi korelasyonu

Bu tezin, veri tabanı üzerinden yayınlanma izni bulunmamaktadır. Yayınlanma izni olmayan tezlerin basılı kopyalarına Üniversite kütüphaneniz aracılığıyla (TÜBESS üzerinden) erişebilirsiniz.ÖZET Kadın seksüel disfonksiyonu yaşam kalitesinde ve ikili ilişkilerde major etkisi olan prevalansı çok yüksek, çok nedenli ve çok yönlü bir sağlık sorunudur. Kadın seksüel disfonksiyonunun en sık görülen formu olan seksüel uyarılma bozukluğunun bir süredir sadece hıpogastrik arteriyel yataktaki bozulmuş kan akımına bağlı olduğu düşünülmekteydi. Bu hipotez, vasküler risk faktörlü yaşlı hastalardaki patofizyolojik mekanizmaları açıklamaktaysa da, vasküler risk faktörü olmayan genç kadınlardaki uyarılma bozukluklarının prevalansını ve mekanizmalarını açıklamaktan uzaktır. Hormonal dengesizlikler, genital arzu ve uyarılma bozukluklarının patofızyolojisine katkıda bulunan önemli faktörler olabilir.Çok kısa bir süre önce yapılan bir çalışmada premenopozal kadınların azalmış testosteron düzeylerine rağmen normal menstrüel siklusa sahip olabildikleri tespit edilmiştir. Bu kadınların ovariyen fonksiyonları normal olduğu kabul edilirse bu kadınlarda testosteronun diğer kaynağı olan adrenal bezde olası bir disfonksiyon olabilir. Eğer bu durum premenopozal kadınlar için doğru ise aynı olasılık postmenopozal kadınlar için de doğru olabilir. Biz 4 aylık bir süreçte temel yakınması azalmış seksüel arzu (azalmış libido) olan 40 hasta ve 20 sağlıklı kadın grubunda çalıştık. Bu prospektif, tek merkezli, kontrol gruplu çalışmanın amacı libidosu düşük kadınlardaki androjen seviyelerini saptamak ve Kadın Seksüel Fonksiyon İndeksi (FSF1) ile korelasyonunu incelemekti. Hasta grubunun 20 ianesi premenopozal (24-51 yıl) ve 20 tanesi de postmenopozaldı (45-70 yıl) ve kontrol grubunun 14 tanesi premenopozal ( 21-51 yıl) 6 tanesi de postmenopozaldı (48-60 yıl). Hasta grubunu oluşturan 40 hastanın %70'inde serbest testosteron seviyeleri düşük bulundu. Hastaların androjen seviyeleri kontrol grubuna göre anlamlı oranda düşük bulundu. Ayrıca hastaların total FSFI skorları ve arzu, uyarılma, lubrikasyon ve tatmin skorları da anlamlı oranda azalmış bulundu ve bu skorlar azalmış androjen seviyeleri ile korelasyon göstermekteydi. Azalmış DIIEA-S seviyeleri hem premenopozal hem de postmenopozal hasta grubunda gözlendi ve bu hastalarda adrenal steroidonezde olası bir defekt düşünüldü. Adrenal steroidogenezdeki defektlerin hangi regülatör mekanizmalarla oluştuğu daha ileri dönemlerdeki çalışmalarla açıklığa kavuşacaktır. Sonrasında da yaşam kaliteleri ve ikili ilişkileri ileri derecede bozulmuş bu kadınların tedavisi mümkün olacaktı

Laparoscopic partial nephrectomy: Newer trends

Objectives: To report the advances in laparoscopic partial nephrectomy (LPN) for renal masses with emphasis on technically challenging cases. Methods: Literature in the English language was reviewed using the National Library of Medicine database using the key words kidney, renal, tumor, nephron sparing surgery, and laparoscopic partial nephrectomy, for the period between 1993 and 2009. Over 500 articles were identified. A total of 50 articles were selected for this review based on their relevance to the evolution of the technique and outcomes, as well as expanding indications for LPN. Results: In expert hands, LPN is safe and effective for central tumors, completely intrarenal tumors, hilar tumors, tumor in a solitary kidney, large tumors requiring heminephrectomy, cystic tumors, multiple tumors, obese patients, and even incidental stage ≥ pT2 tumors. Perioperative outcomes and 5-year oncologic outcomes after LPN are comparable to open partial nephrectomy (OPN). Conclusions: In experienced hands indications for LPN have expanded significantly. In 2009, advanced LPN remains a skill-intensive procedure that can nevertheless provide excellent outcomes for patients with renal tumors

Üreteroskopi: Endikasyonlar ve sonuçlar

Introduction: There have been several advances in ureteroscopic technology in the last 20 years. Specifically, miniaturization of ureteroscopes and improved video imaging as well as laser lithotripsy has expanded the indications for ureteroscopy. This resulted in excellent patient outcomes with low morbidity in the entire upper urinary tract.Son 20 yılda, üreteroskopi teknolojisinde çok ciddi gelişmeler kaydedildi. Özellikle, üreteroskopların minyatürizasyonu ve gelişen video görüntüleme yöntemleri ile birlikte lazer litotripsi, üreteroskopi endikasyonlarını anlamlı oranda artırdı. Böylece, üst üriner sistemin tamamında düşük hasta morbiditesi ile birlikte mükemmel sonuçlar alınmasına olanak sağlandı

A causative analysis on ECDIS-related grounding accidents

Turna, idris/0000-0003-2517-179X; OZTURK, ORKUN BURAK/0000-0002-7596-2277WOS: 000493224800001This study introduces an assessment concerning the use of Electronic Chart Display and Information System (ECDIS) in the safe navigation of vessels by considering the case studies whether the device played a role in grounding accidents. A total 80 investigation reports of grounding accidents from 2008 to 2018 were analysed. in 22 cases, one or more findings related to ECDIS and Electronic Navigational Charts (ENC) were identified. Twenty two accidents related to ECDIS or ENCs were re-analysed with 4M Overturned Pyramid (MOP) model to determine the characteristics and causes of accidents. Causative factors that related ECDIS in the cases have been listed and explained. Results indicate that ECDIS-related procedures and lack of training have led to incorrect settings of the device, especially alarm settings. the recommendations have been arranged that ECDIS devices, which offer much considerable information for the safe navigation of ships, are able to work more efficiently

Analysis of Robotic-assisted Laparoscopic Pyleloplasty for Primary Versus Secondary Repair in 119 Consecutive Cases EDITORIAL COMMENT

WOS: 000301154400058PubMed ID: 2238642