Laparoscopic simple nephrectomy patient with situs inversus totalis and left renal hypoplasia: A case report

Situs inversus totalis (SIT) is a relatively rare anatomical condition characterized by the transposition of thoracic and abdominal organs from the normal side to the opposite position. Most reports of laparoscopic procedures in patients with SIT cite technical difficulties and longer operative times due to disorientation because of the reversed abdominal organs and necessary modification of the surgeon's movements and techniques. We present a case of a patient with SIT in whom a transperitoneal laparoscopic simple nephrectomy was performed

Effects of 5 alpha-reductase inhibitor therapy with dutasteride on bone metabolism in patients with benign prostatic hyperplasia

Objectives: The aim of this study was to investigate the effect of dutasteride on bone metabolism in patients with benign prostate hyperplasia (BPH)

Effects of 5α-reductase inhibitor therapy with dutasteride on bone metabolism in patients with benign prostatic hyperplasia

Objectives: The aim of this study was to investigate the effect of dutasteride on bone metabolism in patients with benign prostate hyperplasia (BPH). Design: Prospective study Setting: Sakarya University Sakarya Training and Research Hospital Subjects: Fifty patients were administered 0.5 mg dutasteride daily for treatment of BPH. Interventions: All patients were evaluated prior and six months after the treatment for bone metabolism. Main outcome measure: Standard parameters of bone metabolism and serum osteoprotogerin (OPG) levels, which is an important regulator for bone metabolism, were evaluated. Results: Seven of the 50 patients were lost to follow up and the remaining 43 patients were included in the study. Mean age of patients was 60.3±5.5 (range: 48-74) years. Dutasteride significantly increased serum testosterone and estradiol levels compared to pretreatment values. Mean OPG level increased from 198.3±40.5 pg/ml to 240±90.1 pg/ml (P=.019). Except T score of femur neck, there was an increase of T-Z scores in the lumbar spine and in the femur neck (P >.05). There was an increase in bone mineral density levels of the body, but only the increase in L4 vertebral value was statistically significant (P <.008). The treatment with dutasteride also caused significant decrease in prostate specific antigen levels and prostate volume as expected. Conclusions: It seems that, in addition to the benefits on prostatism symptoms, the short-term results of 5ARI on bone metabolism are promising

Does the experience of the bedside assistant effect the results of robotic surgeons in the learning curve of robot assisted radical prostatectomy?

ABSTRACT Introduction: The success of the robot assisted radical prostatectomy (RARP) procedures depend on a successful team, however the literature focuses on the performance of a console surgeon. The aim of this study was to evaluate surgical outcomes of the surgeons during the learning curve in relation to the bedside assistant's experience level during RARP. Materials and Methods: We retrospectively reviewed two non - laparoscopic, beginner robotic surgeon's cases, and we divided the patients into two groups. The first surgeon completed the operations on 20 patients with a beginner bedside assistant in February - May 2009 (Group-1). The second surgeon completed operations on 16 patients with an experienced (at least 150 cases) bedside assistant in February 2015 - December 2015 (Group-2). The collected data included age, prostate volume, prostate specific antigen (PSA), estimated blood loss, complications and percent of positive surgical margins. In addition, the elapsed time for trocar insertion, robot docking, console surgery, specimen extraction and total anesthesia time were measured separately. Results: There were no significant differences between the groups in terms of age, comorbidity, prostate volume, PSA value, preoperative Gleason score, number of positive cores, postoperative Gleason score, pathological grade, protection rate of neurovascular bundles, surgical margin positivity, postoperative complications, length of hospital stay, or estimated blood loss. The robot docking, trocar placement, console surgery, anesthesia and specimen extraction times were significantly shorter in group 2 than they were in group 1 (17.75 ± 3.53 min vs. 30.20 ± 7.54 min, p ≤ 0.001; 9.63 ± 2.71 min vs. 14.40 ± 4.52 min, p = 0.001; 189.06 ± 27.70 min vs. 244.95 ± 80.58 min, p = 0.01; 230.94 ± 30.83 min vs. 306.75 ± 87.96 min, p = 0.002; 10.19 ± 2.54 min vs. 17.55 ± 8.79 min, p = 0.002; respectively). Conclusion: Although the bedside assistant's experience in RARP does not appear to influence the robotic surgeon's oncological outcomes during the learning curve, it may reduce the potential complications by shortening the total operation time