BACKGROUND:We evaluated the importance and efficacy of 'stepped procedure' in laparoscopic cyst decortication as an initial experience in it.MATERIALS AND METHODS:A 36 renal cyst cases were included. The stepped retroperitonoscopic cyst excision divided into three groups. First step, doing the incisions to place the ports and expanding the retroperitoneal space with balloon distension, second step, placement of trocars and reach to the cyst, third step, aspiration and decortication of the cyst. The difficulty of the sessions was measured with the Visual Analog Scale (VAS) scoring system. Score was determined according to the difficulty of the surgical step ranging from '0' to '10', '0', too easy, '10' too difficult'. The durations were measured. One-way ANOVA test was used for statistical analysis.RESULTS:The mean age was 52.0 (20-75) years. The mean operation time was 52.0 min. The mean duration of the first step was 12.5, second, 26.0 and third, 22.5 min. The mean VAS of first step, 3.2, second, 6.0 and third, 3.6 There were only significant differences in duration time and VAS score for second step among the surgeons (P<0.05).CONCLUSIONS:Laparoscopic cyst decortication may provide gaining experience to approach the kidney laparoscopically. The side, size and localization of cysts were not found associated with the difficulty of the method.

Objective: In this study, we compared the plasmakinetic (PK) energy and conventional techniques for transurethral resection (TUR-B) in bladder tumor. Materials and methods: Twenty-eight patients diagnosed with bladder tumor were included to the study and randomized into two study groups. First group (GI) had conventional and second group (GII) had PK TUR-B. Age, previous operation number, tumor size, shape, grade, stage, pathologic artefact, operation time, intra-and postoperative complication rates, adductor contraction, and hospitalization time were recorded. At first month, urethral stricture and persistant hematuria were evaluated. Results: Mean age of GI and GII was 58.0, 62.4, respectively. Previous operation number, tumor size, shape, grade and stage were not statistically different between two groups (p>0.05). One (7.1%) patient in GI and 6 (48.5%) patients in GII had multiple tumors (p<0.05). There were no difference in operation time within groups (p>0.05) while hospitalization time was significantly longer in GI (p<0.05). Adductor contraction has not been observed in GI patients, but it has been detected in half of GII patients (p<0.05). In 2 (28.5%) patients of GII, PK energy converted to conventional method due to uncontrollable adductor contraction. In 1 patient of GI, reoperation was required due to post-operative hematuria. Pathologic artefact, urethral stricture, and persistant hematuria were not observed. Conclusion: PK bladder tumor resection may be an effective alternative method of conventional technique with less hospitalization time, especially in multipl tumors. Adductor contraction could be a restrictive factor to use PK technique safely in all bladder tumor.

Objectives: Respiratory complications are an important contributor to morbidity and mortality following lung resection. The surgical techniques used and the patient's pre-operative medical condition determine the severity of complications. The aim of this study is to evaluate the relationship between the perioperative characteristics of patients undergoing lung resection and the development of pulmonary complications (PC). Methods: We retrospectively reviewed the records of 1186 patients who underwent lung resections between 2017 and 2020 and identified 124 patients who developed PC. A group of 215 consecutive patients who underwent surgery during the same period and did not develop complications were included as the control group. The groups were compared to evaluate risk factors for PC. Results:The patients had a mean age of 58.9±12.1 (range, 18-83) years and 82% were men (n=278). Factors significantly associated with PC were age over 65 years, male sex, presence of chronic heart failure, coronary artery disease, and chronic obstructive pulmonary disease, undergoing pneumonectomy, intraoperative use of blood products, reoperation due to bleeding, operative time longer than 4 h, and intraoperative inotrope use. Independent variables for PC were intraoperative inotrope use, preoperative anticoagulant use, revision due to hemorrhage, high Sequential Organ Failure Assessment (SOFA) score, low Forced Expiratory Volume in the 1 st s (FEV1), and low preoperative hemoglobin values. Conclusion:This study demonstrated the presence of many risk factors for PC after lung resection. In our study, independent risk factors for PC; intraoperative inotropic use, preoperative anticoagulant use, revision due to bleeding, high SOFA score, low FEV1, and low preoperative hemoglobin values were observed.

OzetAmaç: Bu çali §mada üreterorenoskopik cerrahide zor olgularm analizi yapilmi §tir. Gereç ve yöntem:Klinigimizde 2001-2008 yillari arasinda ureter taçi tanisiyla endoskopik ureter ta §i tedavisi yapilan ve bu operasyon sirasinda zor olgu olarak degerlendirdigimiz 117 hastanin geriye dönük kayitlari incelendi. Zor olgu degerlendirme kriterleri; üreterde üreterorenoskopun geçi §ini zorlaçtiran ve/veya engelleyen darlik bulunmasi, ta §in üst ureter lokalizasyonu, geçirilmiç üreteral cerrahi varligi ve komorbidite nedeniyle yüksek risk olu §turma olarak belirlendi. Bulgular: Hastalardaki ta § lokalizasyonlari; %77.8 (n=91) alt, %8.5 (n=10) orta ve %13.7 {n=16) üst ureter idi. Ameliyati zorla §tiran darlik hastalann %82'sinde (n=96) üreterin distal ilk 5 cm'lik kismmda görüldü (p<0.05). Hastalarin %40.9'unda {n=47) üreterdeki darlik nedeniyle operasyona devam edilemedi. Operasyona devam edilememe oranlan alt, orta ve üst ureter ta § lokalizasyonunda sirasiyla %39, %70 ve %25 olarak tespit edildi. Sonuç: Endoskopik ureter ta §i tedavisi, zor olgularda da güvenle uygulanabilecek bir cerrahi yöntemdir. Üreteral darlik en sik kar §ila §abilecegimiz zorluk faktörü olabilir. Anahtar sözcükler: Ureter ta §i; üreteral darlik; üreterorenoskopi. Abstract Objective:We have analyzed the difficult cases in ureterorenoscopic surgery in this study. Materials and methods:We have evaluated 117 patients' records retrospectively that has operated because of ureteric stone with ureterorenoscopy, which were evaluated as difficult cases in our clinic between 2001-2008. Difficult case criteria were the stricture that prevents or makes difficult the passage of ureterorenoscope in the ureter, the upper ureteric stones, previous ureteric surgery, high risk patients due to comorbidity. Results: The localization of the stones were 77.8% (n=91) upper ureter, 8.5% (n=10) middle ureter, and 13.7% (n=16) lower ureter The stricture of ureter that complicates the surgery was seen at the first distal 5 cm in 82% (n=96) of the patients (p<0.05). Of the patients, 40.9% (n=47) failed to continue operations due to stricture of the ureter. The operation failure were detected in 39% of lower, 70% of middle, and 25% of upper ureter localized stones. Conclusion: Endoscopie ureter stone surgery could safely be performed in difficult cases, üreteral stricture might be the one of the frequent factors.

Paraganglioma can be found in different parts of the body. In this case report, a rare case of anterior mediastinal paraganlioma was examined. Pheochromocytoma can pose problems in intraoperative anesthesia management. A 17-year-old male patient with an anterior mediastinal mass was first scheduled for thoracoscopic tumor resection, and then proceeded with open thoracotomy. The patient, who was diagnosed with preoperative pheochromocytoma, had a history of dual antihypertensive drug use. The patient, who showed an intraoperative labile course, had episodes of hypertension (270/140 mmHg) and tachycardia (200 bpm). Esmolol and nitroglycerin infusion was applied and intervened. Diagnosis of paraganglioma-related pheochromocytoma can be challenging. Risks can be minimized by making appropriate decisions and interventions before and during the operation.