Intragastric balloons have several advantages such as easy placement and low complication rates o... more Intragastric balloons have several advantages such as easy placement and low complication rates over other bariatric procedures. It is very rare for intragastric balloons to dislodge and give rise to pancreatitis. In this article, we present a case of duodenal obstruction caused by a gastric balloon leading to pancreatitis. A 38-year-old obese female patient had undergone intragastric implantation one month before admission. The patient was admitted to our hospital because of sudden onset of abdominal pain. On the abdominal ultrasonography and tomography, edematous pancreatitis and cholelithiasis were observed. The patient was given medical treatment for pancreatitis. Abdominal ultrasonography was repeated on the next day, and a distended gallbladder was revealed. Thus, the patient was operated on with the pre-diagnosis of acute cholecystitis and biliary pancreatitis. Laparoscopic cholecystectomy was performed. During the operation, a hard and trapped object was determined in the second part of the duodenal lumen. The patient was reevaluated on the second postoperative day as her pain had increased. On direct abdominal X-ray and computed tomography scan, the tubular part of the gastric balloon was found to be stuck in the duodenum. A gastroscopy was performed, but the balloon could not be removed. Therefore, an immediate laparotomy was performed, and the balloon was removed via gastrotomy. Although intragastric balloons are designed to reduce the risk of displacement, all unexpected patient complaints should lead to a thorough examination of the position and status of the balloon.
As an advanced surgical procedure, laparoscopic Roux-en-Y gastric bypass (LRYGB) is associated wi... more As an advanced surgical procedure, laparoscopic Roux-en-Y gastric bypass (LRYGB) is associated with considerable morbidity, especially in the learning curve period. The aim of this study was to evaluate the role of endoscopy during LRYGB surgery in assessing the gastric pouch and anastomosis for air leak, bleeding, and structure at the beginning of a bariatric surgery program. Patients who underwent LRYGB for morbid obesity between May 2008 and May 2009 were included in this study. After the completion of the anastomosis, an endoscopic examination was carried out. The transection line and anastomosis site were examined for bleeding and patency and inspected for air leak under laparoscopic vision. Thirteen morbidly obese patients (mean body mass index, 48.0 ± 6.8 kg/m(2)) were evaluated by endoscopic examination during the LRYGB operation. None of the cases had bleeding at the transection line or anastomosis site. In two patients, air leak test was positive and the anastomosis was reinforced with additional sutures. All the patients, including those with positive air leak test, were discharged from the hospital with no leak complications. After a mean follow-up of 9.1 ± 5.5 months, except for the patient who underwent balloon dilatation, no other patient had anastomotic stricture. Intraoperative endoscopy is invaluable in the assessment of bleeding, anastomotic patency, and air leak during LRYGB, and it might be a helpful auxiliary tool to decrease morbidity during the learning curve period. Also, it helps solve intraoperative problems during the surgery so that postoperative complications might be prevented.
The aim of this study was to experimentally assess and compare the accuracy of the surgical robot... more The aim of this study was to experimentally assess and compare the accuracy of the surgical robots Aesop and Endosista as camera holders for use in laparoscopic surgery. The performance of these two robotic systems was examined for linear (upwards, downwards, diagonal), complex, and "in and out" movements using laparoscopic training boxes. Standard distances and tests were used for each system, and the time required to achieve each task was measured. The majority of the linear movements of the verbal and preprogrammed modes of Aesop were quicker than those of Endosista. Diagonal movements were significantly faster with the preprogrammed-mode Aesop. Complex or three-dimensional movements were also significantly faster with both modes of Aesop than with Endosista. Under the experimental conditions, Aesop, particularly in the preprogrammed mode, is quicker and more accurate than Endosista.
JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons
To compare resection time and collateral thermal damage of 3 currently available ultrasonically a... more To compare resection time and collateral thermal damage of 3 currently available ultrasonically activated devices in laparoscopic small bowel surgery. AutoSonix, SonoSurg, and UltraCision were compared in laparoscopic small bowel mesentery resection in a porcine model. A resection was defined as 12 endarcade arteries supplying the intended bowel segment. Vssels were divided 1 cm off the bowel wall. AutoSonix, SonoSurg, and UltraCision were comparable for blade length and type, cutting mechanism, handle ergonomics, and vibration amplitude, but not well matched for vibration frequency (55.5;23.5;55.5 kHz), working shaft diameter (5;11;10 mm) and length (29;33;34 cm), respectively. A sample size of 114 was calculated to detect a 25% difference with 90% power at a 5% significance level. Resections were allocated to devices by block randomization. Analysis of variance and pairwise Scheffe tests were used for multiple comparisons, and a Kaplan-Meier plot was drawn to confirm differences i...
With the challenges that the health sector now faces in accordance with readjustments and demands... more With the challenges that the health sector now faces in accordance with readjustments and demands for increased efficiency, resource utilization, and innovation, we have initiated a project to develop the future operating room for advanced laparoscopic surgery. New hospitals are being built that contain numerous operating room theaters. To share experiences and avoid repeating the same mistakes as others, we find it suitable to build an "experimental" operating room theater where we can try out and study new equipment, logistics, and communications, and operating forms and new technology that both benefit the establishment of our hospital, as well as the establishment of other hospitals and their laparoscopic operating rooms nationally and internationally. The main goals in the project are, through research and development, to reveal information and develop technology and methods to establish more efficient and prospective patient treatment that is focused on quality. The project is deeply rooted in the established research environment in Trondheim, Norway. We will develop new integrated solutions in the laparoscopic operating unit to create a possibility to rapidly implement the results in the form of practical improvements, increased quality, and renovation in patient treatment. The goal is also that this will result in the establishment of new industry nationally.
A fiber optic light source is the central part of endoscopic surgery. However, the light generati... more A fiber optic light source is the central part of endoscopic surgery. However, the light generation process causes heat transmission from a source to tip of a scope. In this study, we measured the amount of heating and pathologic effects of direct contact with the tip of scopes on the small bowel in an experimental set-up. Temperature measurements were performed at the tip of 4 different scopes (Aesculap, Olympus, Karl Storz, and Richard Wolf), which were connected to either of 3 different xenon light sources (Olympus, Richard Wolf, Karl Storz). Temperatures at the outlet of light sources and the tip of fiber optic cables were measured as well. Tissue samples from the small bowel of a pig were obtained after exposing them to direct contact with the tip of the scopes or the fiber optic cable. The temperature measurements at the tip of the scopes varied between 60 degrees C and 100 degrees C (Celsius). The temperatures showed a wide variation according to the type of light source and fiber optic cable the scopes were connected to. The average temperature at the outlet of the light sources and the tip of fiber optic cables was 750 degrees C and 250 degrees C, respectively. The microscopic scores of the small bowel injury induced by exposition to the heat at the tip of the scopes were significantly high after 5 seconds of contact. Direct contact of the tip of the fiber optic cable caused total carbonization in the wall of the small bowel. Direct contact of the tip of the scope with small bowel may cause functional and cytologic injury even after short durations of exposure. Therefore, we do not recommend direct contact of scopes with the intra-abdominal organs to avoid heat injuries. In addition, this study also emphasizes the variation in heat generation at the tip of the scopes when used with a mismatching light source and fiber optic cable.
... Presented at the Karl Storz prize session of the Seventh International Con-gress of the Europ... more ... Presented at the Karl Storz prize session of the Seventh International Con-gress of the European Association for Endoscopic Surgery (EAES), Linz, Austria, 23-26 June 1999 Correspondence to: Y. Yavuz ... Katircioglu SF, Atalay F, Keskin A, Saritas Z, Bostanogin S, Yucel D, ...
Complications may be avoided by exactly clarifying the structures in the operative field during l... more Complications may be avoided by exactly clarifying the structures in the operative field during laparoscopic surgery. We aimed to study the efficiency of a new ultrasonic Doppler device, SonoDoppler, which offers an easy and efficient way of mapping the anatomy. The design of the study was prospective, open observational and carried out on a sample of 51 patients who were operated on in four hospitals. The surgeons were asked to identify a common hepatic artery, cystic artery and portal vein during a laparoscopic cholecystectomy, and corresponding structures during other laparoscopic procedures using the SonoDoppler, instrument. Total operation time (skin-to-skin) and duration of the SonoDoppler, use were measured. The main outcome measures were gain of additional safety and clinical value. A number of evaluations concerning the ergonomics, functionality and interactions with other instruments were also carried out. The SonoDoppler, instrument has the potential to help to assess and clarify the anatomy during laparoscopic procedures. Its use can be advocated not only for inexperienced surgeons, to help them map the vessels during surgery, but also for experienced surgeons during complicated cases and advanced procedures.
Journal of Hepato-Biliary-Pancreatic Surgery, 1996
We describe a patient in whom postoperative bleeding from the sphincteroplasty site was successfu... more We describe a patient in whom postoperative bleeding from the sphincteroplasty site was successfully controlled by infusion of epinephrine through a T-tube. This method may represent another alternative for the conservative treatment of patients, if they have a T-tube in situ, who bleed after sphincteroplasty or sphincterotomy.
Intragastric balloons have several advantages such as easy placement and low complication rates o... more Intragastric balloons have several advantages such as easy placement and low complication rates over other bariatric procedures. It is very rare for intragastric balloons to dislodge and give rise to pancreatitis. In this article, we present a case of duodenal obstruction caused by a gastric balloon leading to pancreatitis. A 38-year-old obese female patient had undergone intragastric implantation one month before admission. The patient was admitted to our hospital because of sudden onset of abdominal pain. On the abdominal ultrasonography and tomography, edematous pancreatitis and cholelithiasis were observed. The patient was given medical treatment for pancreatitis. Abdominal ultrasonography was repeated on the next day, and a distended gallbladder was revealed. Thus, the patient was operated on with the pre-diagnosis of acute cholecystitis and biliary pancreatitis. Laparoscopic cholecystectomy was performed. During the operation, a hard and trapped object was determined in the second part of the duodenal lumen. The patient was reevaluated on the second postoperative day as her pain had increased. On direct abdominal X-ray and computed tomography scan, the tubular part of the gastric balloon was found to be stuck in the duodenum. A gastroscopy was performed, but the balloon could not be removed. Therefore, an immediate laparotomy was performed, and the balloon was removed via gastrotomy. Although intragastric balloons are designed to reduce the risk of displacement, all unexpected patient complaints should lead to a thorough examination of the position and status of the balloon.
As an advanced surgical procedure, laparoscopic Roux-en-Y gastric bypass (LRYGB) is associated wi... more As an advanced surgical procedure, laparoscopic Roux-en-Y gastric bypass (LRYGB) is associated with considerable morbidity, especially in the learning curve period. The aim of this study was to evaluate the role of endoscopy during LRYGB surgery in assessing the gastric pouch and anastomosis for air leak, bleeding, and structure at the beginning of a bariatric surgery program. Patients who underwent LRYGB for morbid obesity between May 2008 and May 2009 were included in this study. After the completion of the anastomosis, an endoscopic examination was carried out. The transection line and anastomosis site were examined for bleeding and patency and inspected for air leak under laparoscopic vision. Thirteen morbidly obese patients (mean body mass index, 48.0 ± 6.8 kg/m(2)) were evaluated by endoscopic examination during the LRYGB operation. None of the cases had bleeding at the transection line or anastomosis site. In two patients, air leak test was positive and the anastomosis was reinforced with additional sutures. All the patients, including those with positive air leak test, were discharged from the hospital with no leak complications. After a mean follow-up of 9.1 ± 5.5 months, except for the patient who underwent balloon dilatation, no other patient had anastomotic stricture. Intraoperative endoscopy is invaluable in the assessment of bleeding, anastomotic patency, and air leak during LRYGB, and it might be a helpful auxiliary tool to decrease morbidity during the learning curve period. Also, it helps solve intraoperative problems during the surgery so that postoperative complications might be prevented.
The aim of this study was to experimentally assess and compare the accuracy of the surgical robot... more The aim of this study was to experimentally assess and compare the accuracy of the surgical robots Aesop and Endosista as camera holders for use in laparoscopic surgery. The performance of these two robotic systems was examined for linear (upwards, downwards, diagonal), complex, and "in and out" movements using laparoscopic training boxes. Standard distances and tests were used for each system, and the time required to achieve each task was measured. The majority of the linear movements of the verbal and preprogrammed modes of Aesop were quicker than those of Endosista. Diagonal movements were significantly faster with the preprogrammed-mode Aesop. Complex or three-dimensional movements were also significantly faster with both modes of Aesop than with Endosista. Under the experimental conditions, Aesop, particularly in the preprogrammed mode, is quicker and more accurate than Endosista.
JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons
To compare resection time and collateral thermal damage of 3 currently available ultrasonically a... more To compare resection time and collateral thermal damage of 3 currently available ultrasonically activated devices in laparoscopic small bowel surgery. AutoSonix, SonoSurg, and UltraCision were compared in laparoscopic small bowel mesentery resection in a porcine model. A resection was defined as 12 endarcade arteries supplying the intended bowel segment. Vssels were divided 1 cm off the bowel wall. AutoSonix, SonoSurg, and UltraCision were comparable for blade length and type, cutting mechanism, handle ergonomics, and vibration amplitude, but not well matched for vibration frequency (55.5;23.5;55.5 kHz), working shaft diameter (5;11;10 mm) and length (29;33;34 cm), respectively. A sample size of 114 was calculated to detect a 25% difference with 90% power at a 5% significance level. Resections were allocated to devices by block randomization. Analysis of variance and pairwise Scheffe tests were used for multiple comparisons, and a Kaplan-Meier plot was drawn to confirm differences i...
With the challenges that the health sector now faces in accordance with readjustments and demands... more With the challenges that the health sector now faces in accordance with readjustments and demands for increased efficiency, resource utilization, and innovation, we have initiated a project to develop the future operating room for advanced laparoscopic surgery. New hospitals are being built that contain numerous operating room theaters. To share experiences and avoid repeating the same mistakes as others, we find it suitable to build an "experimental" operating room theater where we can try out and study new equipment, logistics, and communications, and operating forms and new technology that both benefit the establishment of our hospital, as well as the establishment of other hospitals and their laparoscopic operating rooms nationally and internationally. The main goals in the project are, through research and development, to reveal information and develop technology and methods to establish more efficient and prospective patient treatment that is focused on quality. The project is deeply rooted in the established research environment in Trondheim, Norway. We will develop new integrated solutions in the laparoscopic operating unit to create a possibility to rapidly implement the results in the form of practical improvements, increased quality, and renovation in patient treatment. The goal is also that this will result in the establishment of new industry nationally.
A fiber optic light source is the central part of endoscopic surgery. However, the light generati... more A fiber optic light source is the central part of endoscopic surgery. However, the light generation process causes heat transmission from a source to tip of a scope. In this study, we measured the amount of heating and pathologic effects of direct contact with the tip of scopes on the small bowel in an experimental set-up. Temperature measurements were performed at the tip of 4 different scopes (Aesculap, Olympus, Karl Storz, and Richard Wolf), which were connected to either of 3 different xenon light sources (Olympus, Richard Wolf, Karl Storz). Temperatures at the outlet of light sources and the tip of fiber optic cables were measured as well. Tissue samples from the small bowel of a pig were obtained after exposing them to direct contact with the tip of the scopes or the fiber optic cable. The temperature measurements at the tip of the scopes varied between 60 degrees C and 100 degrees C (Celsius). The temperatures showed a wide variation according to the type of light source and fiber optic cable the scopes were connected to. The average temperature at the outlet of the light sources and the tip of fiber optic cables was 750 degrees C and 250 degrees C, respectively. The microscopic scores of the small bowel injury induced by exposition to the heat at the tip of the scopes were significantly high after 5 seconds of contact. Direct contact of the tip of the fiber optic cable caused total carbonization in the wall of the small bowel. Direct contact of the tip of the scope with small bowel may cause functional and cytologic injury even after short durations of exposure. Therefore, we do not recommend direct contact of scopes with the intra-abdominal organs to avoid heat injuries. In addition, this study also emphasizes the variation in heat generation at the tip of the scopes when used with a mismatching light source and fiber optic cable.
... Presented at the Karl Storz prize session of the Seventh International Con-gress of the Europ... more ... Presented at the Karl Storz prize session of the Seventh International Con-gress of the European Association for Endoscopic Surgery (EAES), Linz, Austria, 23-26 June 1999 Correspondence to: Y. Yavuz ... Katircioglu SF, Atalay F, Keskin A, Saritas Z, Bostanogin S, Yucel D, ...
Complications may be avoided by exactly clarifying the structures in the operative field during l... more Complications may be avoided by exactly clarifying the structures in the operative field during laparoscopic surgery. We aimed to study the efficiency of a new ultrasonic Doppler device, SonoDoppler, which offers an easy and efficient way of mapping the anatomy. The design of the study was prospective, open observational and carried out on a sample of 51 patients who were operated on in four hospitals. The surgeons were asked to identify a common hepatic artery, cystic artery and portal vein during a laparoscopic cholecystectomy, and corresponding structures during other laparoscopic procedures using the SonoDoppler, instrument. Total operation time (skin-to-skin) and duration of the SonoDoppler, use were measured. The main outcome measures were gain of additional safety and clinical value. A number of evaluations concerning the ergonomics, functionality and interactions with other instruments were also carried out. The SonoDoppler, instrument has the potential to help to assess and clarify the anatomy during laparoscopic procedures. Its use can be advocated not only for inexperienced surgeons, to help them map the vessels during surgery, but also for experienced surgeons during complicated cases and advanced procedures.
Journal of Hepato-Biliary-Pancreatic Surgery, 1996
We describe a patient in whom postoperative bleeding from the sphincteroplasty site was successfu... more We describe a patient in whom postoperative bleeding from the sphincteroplasty site was successfully controlled by infusion of epinephrine through a T-tube. This method may represent another alternative for the conservative treatment of patients, if they have a T-tube in situ, who bleed after sphincteroplasty or sphincterotomy.
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Papers by Yunus Yavuz