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Permanent URI for this collectionhttps://hdl.handle.net/20.500.14288/3
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Publication Metadata only Novel vaginal cerclage assisted laparoscopic cervico-sacropexy technique for uterovaginal prolapse(SAGE Publications Ltd, 2024) Aydın, Serdar; Çekiç, Sebile Güler; School of Medicine; Koç University HospitalAim Laparoscopic hysteropexy is a complicated procedure that requires specialized surgical skills, including precise dissection and suturing. The aim is to describe the technical considerations for performing a new, feasible, and minimally invasive technique to correct apical and concurrent apical and anterior vaginal wall defects.Method A retrospective analysis was conducted on 70 consecutive women who underwent surgery for stage >= 3 uterovaginal prolapse. As a part of the technique, an anterior 2-cm long transverse incision was made at the anterior cervicovaginal junction, and the bladder was dissected through blunt and sharp dissection to the level of the isthmus. A posterior colpotomy was performed. A polypropylene tape was inserted into the cervical connective tissue, and the free arms of the tape were inserted into the peritoneum via the posterior colpotomy. Two arms of the tape were passed from the tunnel parallel and medial to a right sacrouterine fold, then fixed to the anterior longitudinal ligament via the laparoscopic route.Results The tape can be inserted into the cervix in a median of 15 min, and the laparoscopy procedure can be completed in 24 min. No mesh erosion or long-term complications occurred. At a 1-year control, there were no cases of recurrence.Conclusions This novel cervico-sacrocolpopexy technique is a feasible and safe, minimally invasive way to correct apical or multicompartment defects, with a short operation time and an anatomical result that mimics the normal sacrouterine ligament.Publication Metadata only Tailored indications for different neurotoxins(Lippincott Williams & Wilkins, 2023) Sezgin, Billur; School of MedicineBackground: Minimally invasive procedures have become increasingly popular because they require minimal downtime and are effective for achieving a more youthful appearance. All U.S. Food and Drug Administration-approved neurotoxins are indicated for achieving similar effects, even though they are different in regard to structure, manufacturing technique, and storage requirements. It is agreed upon that each neurotoxin is unique and therefore not interchangeable. The aim of the author is to provide an approach for choosing the optimal toxin in different indications regarding the area of treatment, the age and characteristics of the patient, potential risks, and ultimate goals. Methods:As the country that the author practices carries onabotulinum (ONA), prabotulinum (PRA), and abobotulinum (ABO) toxin type-A, one of these three toxins was preferred for each category. ABO toxins were preferred in wide areas due to the broader action halo. Typical examples include hyperhidrosis treatment, wide forehead area, and calf slimming. In areas where very precise and targeted treatment is required, PRA and ONA toxins were preferred to limit potential side effects due to wider diffusion. First-time patients were typically treated with PRA toxins for a softer trial periods where as "repeat" patients were successfully treated with ABO toxins. Results: No toxin is superior to the other in terms of producing effects. Yet, small differences in their properties can allow the plastic surgeon to cater to each patient's needs while yielding the most optimal results.Conclusions:This study is meant to serve as a guideline for choosing the ideal toxin in different patient settings and indications.Publication Metadata only Percutaneous endoscopic translaminar approach in a patient with pedicle screw malposition and cement leakage(Taylor and Francis Ltd., 2023) Şentürk, Salim; Ünsal, Ülkün Ünlü; Koç University HospitalWe present a 79-year-old female patient who had L2–5 dynamic stabilization with cement (Polymethylmethacrylate) injection 6 weeks prior. Due to post-operative right radicular pain, a lumbar CT was scheduled in which a malposition of the right L4 screw and cement leakage was observed. Via a percutaneous translaminar endoscopic approach the leaked cement was removed and the portion of the screw in contact with the nerve root was drilled. With this minimal-invasive procedure, the patient was relieved of her radicular pain.Publication Metadata only Can TRIF/TICAM-1 dependent pathway be target pathway in lumbar intervertebral disc degeneration?(Turkish Neurosurgical Society, 2023) ALIZADA, Orkhan; AKYOL, Sibel; OZLEN, Fatma; CETINTAS, Semih Can; TURK, Okan; HANCI, Murat; N/A; Akgün, Mehmet Yiğit; N/A; Koç University HospitalAIM: To elucidate the role of the TIR-domain-containing adaptor-inducing interferon-β (TRIF) dependent pathway in intervertebral disc degeneration (IVD). MATERIAL and METHODS: A total of adult male patients with low back pain (LBP) (+/- radicular pain) were further evaluated by magnetic resonance imaging (MRI) with surgical indication for microscopic lumbar disc herniation (LDH). Preoperatively, patients were classified according to Modic Changes (MC), nonsteroidal anti-inflammatory drugs (NSAIDs) use, and the presence of radicular pain in addition to the LBP. RESULTS: The age of the 88 patients ranged from 19 to 75 years (mean: 47.3 ± 19.6 years). Twenty eight of the patients were evaluated as MC I (31.8%), 40 as MC II (45.4%), and 20 as MC III (22.7%). The majority of patients (81.8%) had radicular LBP, while 16 patients (18.1%) had only LBP. Predominantly, 55.6% of all patients were taking NSAIDs. Levels of all adaptor molecules were highest in the MC I group and lowest in the MC III group. The levels of IRF3, TICAM1, TICAM2, NF-kB p65, TRAF6, and TLR4 were significantly increased in the MC I group compared to the MC II and MC III groups. The variations of the individual adaptor molecules showed no statistically significant difference in the use of NSAIDs and radicular LBP. CONCLUSION: As a result of the impact assessment, the current study clearly demonstrated for the first time that the TRIF-dependent signalling pathway plays a crucial role in the degeneration process in human lumbar intervertebral disc specimens. © 2023. All Right Reserved.Publication Metadata only Is the modular dynamic system as effective as classical dynamic systems in long segment dynamic thoracolumbar stabilization?(Turkish Neurosurgical Society, 2024) N/A; Günerbüyük, Caner; Akgün, Mehmet Yiğit; Özer, Ali Fahir; School of Medicine; Koç University HospitalAIM: To evaluate the outcomes of dynamic stabilization in the multilevel degenerative spondylotic spine, and to compare the two dynamic systems (Dynesys (R) and Orthrus (R)) to reveal the increasing role of dynamic systems in the management of the degenerative spine. MATERIAL and METHODS: A total of 74 patients who received dynamic stabilization for degenerative pathologies were retrospectively analyzed. Demographic details: preoperative data including neurological status, pain scores, and radiology; and intraoperative data including blood loss, duration of surgery, complications, and postoperative data including the neurologic status, duration of hospital stay, and pain scores were examined. RESULTS: Patients in both groups showed statistically significant improvements in their Visual Analog Scale and Oswestry Disability Index scores. Significant corrections of thoracic kyphosis (T2 -T12), the sagittal vertical axis, and T10 -L2 thoracolumbar kyphosis were obtained in our cohort (p<0.05). A total of 4 patients received revision surgery due to screw loosening. Patients were discharged after 3-4 days and mobilized on the first postoperative day. CONCLUSION: We did not experience any serious issues in terms of stabilization in the cases in which we employed both systems. Our patients' clinical results were satisfactory in both systems. Existing systems can be used safely even in long -segment stabilization surgeries.Publication Metadata only Transient ageusia and dysgeusia following thalamic cyst drainage(Turkish Neurosurgical Society, 2024) N/A; Nokay, Aziz Emre; Erden, Mert Emre; Samancı, Mustafa Yavuz; Peker, Selçuk; School of MedicineTaste consists of sensation and perception. Specific neural structures transmit a stimulus from the taste buds to the gustatory cortex to generate taste sensation. Any disruption of this pathway, whether it affects sensation or perception, can result in taste disorders. Stereotactic procedures involving the thalamus may result in gustatory complications. A 41-year-old female patient who underwent stereotactic drainage of a thalamic cyst suffered transient ageusia. Subsequently, she developed metallic taste perception. When her stereotactic plan was re-evaluated, it was noted that the posteromedial ventral thalamus nucleus was in the path of the needle tract and the needle had passed through it. Follow-up was recommended and her symptoms completely resolved within 2 months following surgery. Modern imaging techniques allow for the visualization of neural structures related to the sense of taste. Additionally, care must be taken when planning stereotactic procedures for such lesions.Publication Metadata only Can weight of the resected stomach predict weight loss results after laparoscopic sleeve gastrectomy?(Lippincott Williams and Wilkins, 2024) Sobutay, Erman; Bilgic, Cagri; Kabaoglu, Burcak; N/A; Yavuz, Yunus; School of MedicineBackground: Laparoscopic sleeve gastrectomy (LSG) is the most commonly performed bariatric procedure worldwide. Many factors have been investigated in the literature to predict weight loss outcomes after LSG. However, insufficient data regarding the resected stomach weight (RGW) exists. This retrospective study aimed to investigate the association between RGW and weight loss outcomes 1 year after LSG. Materials and Methods: Fifty-four patients who underwent LSG in a tertiary care center were evaluated retrospectively. The statistical analyses were performed to investigate the correlation between preoperative demographics, RGW, and the excess weight loss percentage (%EWL) and percent total weight loss (%TWL). Results: The mean RGW was 169.7 +/- 40.1, ranging from 101 to 295 grams. The RGW was significantly correlated with preoperative weight (r=0.486; P<0.001), body mass index (r=0.420; P=0.002), and age (r=0.327; P=0.01). However, RGW did not predict postoperative weight loss, as measured by percent total weight loss (%TWL) and percent excess weight loss (%EWL), respectively (r=0.044; P=0.75 and r=-0.216; P=0.11). Multiple linear regression analysis identified age as a negative predictor for both %TWL (beta=-0.351, P=0.005) and %EWL (beta=-0.265, P=0.03), while preoperative body mass index was a negative predictor for %EWL (beta=-0.469, P<0.001). Conclusion: The RGW, although correlated with patient characteristics, does not serve as a reliable predictor of postoperative weight loss in the first year after LSG. Further research is needed to improve predictive models and patient care in bariatric surgery.Publication Metadata only Integration of virtual and traditional medical education: scholarship pivots from the Covid-19 pandemic(Lippincott Williams and Wilkins, 2024) Tang, Sherry Y. Q.; Kozlow, Jeffrey H.; Sandhu, Gurjit; Cederna, Paul S.; Berberoğlu, İpek; Sezgin, Billur; ; School of Medicine;Background: The coronavirus disease 2019 (COVID-19) pandemic required an unprecedented transformation of medical education, shifting from traditional, in-person learning to distanced, online learning. This study aimed to review changes to medical education and describe the advantages and disadvantages of virtual medical education experienced by medical students during the pandemic. Methods: An online survey study was conducted at two medical schools, University of Michigan Medical School in the United States and Koc University School of Medicine in Turkey. Medical students completed questionnaires regarding their educational experience before and during the pandemic. Survey instruments were designed to assess differences in the educational curriculum, study methods, clinical skills self-evaluations, perceptions of the quality of in-person and online learning, and overall satisfaction. Results: A total of 184 medical students completed the survey. There was an increase in the use of online study tools since the pandemic. There was no statistically significant difference in self-reported assessments of clinical preparedness and overall clinical competence during surgical clerkship. The percentage of students interested in pursuing a career in surgery has nearly doubled from 34% to 63%. A majority of students (83%) believed that the time available for self-study and research increased during the pandemic. Fifty-two percent of students believed that online education is less efficacious than in-person education, but 86% of students still preferred a blended approach. Conclusions: Medical schools have continued to update their curricula following the COVID-19 pandemic. This study illustrates the transformations in medical education to ensure that the most effective and suitable teaching is delivered.Publication Metadata only Does long segment subarachnoido-subarachnoid shunt prevent posttraumatic and postinfectious spinal arachnoid cyst recurrence?: technical note and case series(Elsevier Masson S.R.L., 2024) ; Akgün, Mehmet Yiğit; Ateş, Özkan; Akyoldaş, Göktuğ; Öktenoğlu, Bekir Tunç; Tepebaşılı, Mehmet Ali; Sasani, Mehdi; Özer, Ali Fahir; ; School of Medicine; Koç University HospitalSyringomyelia associated with extensive spinal adhesive arachnoiditis (SAA) can be defined as a rare but progressive disease with potentially devastating clinical consequences. Diagnosis can be challenging due to the absence of specific clinical findings, confusion with other pathologies, and late imaging modalities. The treatment strategy for syringomyelia associated with extensive SAA should include direct drainage of the syringomyelia, and dissection of the adhesive arachnoid with expansive duraplasty. Hence, several approaches have been reported for arachnoid dissection and decompression of the subarachnoid space. The high risk of recurrence after the operation is one of the most challenging situations. First two cases were operated previously, and the cyst walls were removed and anastomosed to the intact subarachnoid space at the upper and lower ends by each other. However, in both cases, the cyst recurred after a short time and they were anastomosed again in our clinic. A subarachnoid-subarachnoid shunt was placed with a multi-hole silicone tube extending to the proximal and distal intact subarachnoid spaces and passing through the cyst removal area. In our third case, the shunt system we described was applied directly, and satisfactory results were obtained in the clinical follow-up of the patient. It has been demonstrated that subarachnoido-subarachnoid shunt is a very satisfactory treatment option for this type of pathology, which is difficult to follow and treat. © 2024 Elsevier Masson SASPublication Metadata only Roles, experience and views of nurses working in robotic surgery settings: a mixed-methods study(Sage Publications Ltd, 2024) Tunçbilek, Zahide; Topaktaş, Gülsen; Çelik, Sevilay Şenol; Sarıköse, Seda; Canda, Abdullah Erdem; School of Nursing; School of MedicineRobotic-assisted surgery has benefits for patients, but there are challenges to working in this field. In Turkey, training is not provided for nurses working in robotic-assisted surgery, and national legislation on nurses’ roles in these settings has not been implemented. This study aimed to demonstrate the roles and experiences of nurses in robotic-assisted surgery in Turkey. This study was conducted as a mixed-methods research. The qualitative data were analysed by content analysis. More than half of the nurses had received basic training in robotic-assisted surgery. Qualitative data consisted of five themes, including the effects of robotic surgery, feelings and thoughts on robotic surgery, working as a nurse in robotic surgery settings, responsibilities of nurses and competence of nurses working in robotic surgery settings. Determining the working conditions and roles of nurses working in robotic-assisted surgery settings by policymakers in regulations is crucial for improving the quality of nursing care and the outcomes of patients. © The Author(s) 2024.