Researcher:
Esen, Tarık

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Tarık

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Esen

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Now showing 1 - 10 of 80
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    Publication
    Experiences of perioperative nurses with robotic-assisted surgery: a systematic review of qualitative studies
    (Springer Nature, 2023) Ozdemir Koken, Zeliha; Çelik, Sevilay Şenol; Canda, Abdullah Erdem; Esen, Tarık; School of Nursing; School of Medicine
    To determine the experiences of perioperative nurses with robotic-assisted surgery is needed to improve the robotic-assisted surgery practices. This study systematically reviewed and analysed the qualitative studies concerning perioperative nurses’ experiences of robotic-assisted surgery. This systematic literature review included studies up to December 2020. The study data were analysed using inductive content analysis. This systematic review included six articles. There were a total of 71 nurses who participated in the included articles (min = 6, max = 17). Their mean age was 35.7, and their experience in robotic-assisted surgery ranged from 8 months to 10 years. Content analysis generated six categories: adaptation to robotic-assisted surgery technology, the importance of teamwork in robotic-assisted surgery, changing tasks and responsibilities in robotic-assisted surgery, training requirements for robotic-assisted surgery, the effects of robotic-assisted surgery on patients and patient safety, and difficulties with robotic-assisted surgery. A variety of themes and sub-themes emerged in these categories. The review highlights the importance of developing new ways of thinking about the assessment and management of disruptions, developing different teamwork patterns and communication skills, and overcoming the challenges involved in technologically advanced surgeries. Nurses’ roles in robotic technology should be redefined in healthcare. Nurses should learn how to adapt to advancing technology and how to supplement and enhance their skills.
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    The role of PSMA PET/CT in predicting downgrading in patients with Gleason score 4+4 prostate cancer in prostate biopsy
    (Springer, 2024) N/A; Aykanat, İbrahim Can; Kordan, Yakup; Seymen, Hülya; Köseoğlu, Ersin; Özkan, Arif; Esen, Barış; Tarım, Kayhan; Kulaç, İbrahim; Falay, Fikri Okan; Gürses, Bengi; Baydar, Dilek Ertoy; Canda, Abdullah Erdem; Balbay, Mevlana Derya; Demirkol, Mehmet Onur; Esen, Tarık; School of Medicine; Koç University Hospital
    Background To investigate the predictable parameters associated with downgrading in patients with a Gleason score (GS) 8 (4+4) in prostate biopsy after radical prostatectomy. Methods We retrospectively analyzed 62 patients with a GS of 4+4 on prostate biopsy who underwent robotic radical prostatectomy between 2017 and 2022. Results 38 of 62 (61.2%) were downgraded. In multivariable logistic regression model, Ga-68 prostate-specific membrane antigen (PSMA) positron-emission tomography (PET)/computed tomography (CT) SUV max was independent predictor of downgrading (OR 0.904; p = 0.011) and a Logistic Regression model was constructed using the following formula: Y = 1.465-0.95 (PSMA PET/CT SUV max). The model using this variable correctly predicted the downgrading in 72.6% of patients. The AUC for PSMA PET/CT SUV max was 0.709 the cut off being 8.8. A subgroup analysis was performed in 37 patients who had no other European Association of Urology (EAU) high risk features. 25 out of 37 (67.5%) were downgraded, and 21 of these 25 had organ confined disease. Low PSMA SUV max (<8.1) and percentage of GS 4+4 biopsy cores to cancer bearing cores (45.0%) were independently associated with downgrading to GS 7. Conclusion PSMA PET/CT can be used to predict downgrading in patients with GS 4+4 PCa. Patients with GS 4+4 disease, but no other EAU high risk features, low percentage of GS 4+4 biopsy cores to cancer bearing cores, and a low PSMA PET/CT SUV max are associated with a high likelihood of the cancer reclassification to intermediate risk group.
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    Natural history of histologically benign PIRADS 4-5 lesions in multiparametric MRI: real-life experience in an academic center
    (Wiley, 2024) Madendere, Serdar; Kılıç, Mert; Zoroğlu, Hatice; Coşkun, Bilgen; Vural, Metin; Sarıkaya, Ahmet Furkan; Veznikli, Mert; Armutlu, Ayşe; Kulaç, İbrahim; Gürses, Bengi; Kiremit, Murat Can; Baydar, Dilek Ertoy; Canda, Abdullah Erdem; Balbay, Mevlana Derya; Kordan, Yakup; Esen, Tarık; School of Medicine; Koç University Hospital
    IntroductionThe follow-up findings of patients who underwent prostate biopsy for prostate image reporting and data system (PIRADS) 4 or 5 multiparametric magnetic resonance imaging (mpMRI) findings and had benign histology were retrospectively reviewed. MethodsThere were 190 biopsy-naive patients. Patients with at least 12 months of follow-up between 2012 and 2023 were evaluated. All MRIs were interpreted by two very experienced uroradiologists. Of the patients, 125 had either cognitive or software fusion MR-targeted biopsies with 4 + 8/10 cores. The remaining 65 patients had in-bore biopsies with 4-5 cores. Prostate-specific antigen (PSA) levels below 4 ng/mL were defined as PSA regression following biopsy. PIRADS 1-3 lesions on new MRI images were classified as MRI regression. ResultsMedian patient age and PSA were 62 (39-82) years and six (0.4-33) ng/mL, respectively, at the initial work-up. During a median follow-up period of 44 months, 37 (19.4%) patients were lost to follow-up. Of the remaining 153 patients, 82 (53.6%) had persistently high PSA. Among them, 72 (87.8%) had repeat mpMRI within 6-24 months which showed regressive findings (PIRADS 1-3) in 53 patients (73.6%) and PIRADS 4-5 index lesion persistence in 19 cases (26.4%). The latter group was recommended to have rebiopsy. Of these 19 patients, 16 underwent MRI-targeted rebiopsy. Prostate cancer was diagnosed in six (37.5%) patients and of these four (25%) were clinically significant (>Grade Group 1). Totally, clinically significant prostate cancer was detected in 4/153 (2.6%) patients followed up. ConclusionPatients should be warned against the relative relaxing effect of a negative biopsy after identification of PIRADS 4-5 index lesion. While PSA decrease was observed in many patients during follow-up, persistent MRI findings were present in nearly a quarter of patients with persistently high PSA. A rebiopsy is warranted in these patients, with significant prostate cancer diagnosed in a quarter of patients with rebiopsy.
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    The effect of ultrasound-guided rectus sheath block on postoperative analgesia in robot assisted prostatectomy: a randomized controlled trial
    (Lippincott Williams and Wilkins, 2024) Kılıç, Mert; Coşarcan, Sami Kaan; Gürkan, Yavuz; Manici, Mete; Özdemir, İrem; Esen, Tarık; Erçelen, Ömür; School of Medicine; Koç University Hospital
    Background:Postoperative pain continues to represent an important problem even after minimally invasive robotic-assisted laparoscopic radical prostatectomy, which results in discomfort in the postoperative period and sometimes prolongs hospital stays. Regional anesthesia and analgesia techniques are used in addition to systemic analgesics with the multimodal approach in postoperative pain management. Ultrasound-guided fascial plane blocks are becoming increasingly important, especially in minimally invasive surgeries. Another important cause of discomfort is urinary catheter pain.The present randomized controlled study investigated the effect of rectus sheath block on postoperative pain and catheter-related bladder discomfort in robotic prostatectomy operations. Methods:This randomized controlled trial was conducted from March to August 2022. Written informed consent was obtained from all participants. Approval for the study was granted by the Clinical Research Ethics Committee. All individuals provided written informed consent, and adults with American Society of Anesthesiologists Physical Condition classification I to III planned for robotic prostatectomy operations under general anesthesia were enrolled. Following computer-assisted randomization, patients were divided into 2 groups, and general anesthesia was induced in all cases. Rectus sheath block was performed under general anesthesia and at the end of the surgery. No fascial plane block was applied to the patients in the non-rectus sheath block (RSB) group.Postoperative pain and urinary catheter pain were assessed using a numerical rating scale. Fentanyl was planned as rescue analgesia in the recovery room. In case of numerical rating scale scores of 4 or more, patients were given 50 mu g fentanyl IV, repeated if necessary. The total fentanyl dose administered was recorded in the recovery room. IV morphine patient-controlled analgesia was planned for all patients. All patients' pain (postoperative pain at surgical site and urethral catheter discomfort) scores and total morphine consumption in the recovery unit and during follow-ups on the ward (3, 6, 12, and 24 hours) in the postoperative period were recorded. Methods: This randomized controlled trial was conducted from March to August 2022. Written informed consent was obtained from all participants. Approval for the study was granted by the Clinical Research Ethics Committee. All individuals provided written informed consent, and adults with American Society of Anesthesiologists Physical Condition classification I to III planned for robotic prostatectomy operations under general anesthesia were enrolled. Following computer-assisted randomization, patients were divided into 2 groups, and general anesthesia was induced in all cases. Rectus sheath block was performed under general anesthesia and at the end of the surgery. No fascial plane block was applied to the patients in the non-rectus sheath block (RSB) group.Postoperative pain and urinary catheter pain were assessed using a numerical rating scale. Fentanyl was planned as rescue analgesia in the recovery room. In case of numerical rating scale scores of 4 or more, patients were given 50 mu g fentanyl IV, repeated if necessary. The total fentanyl dose administered was recorded in the recovery room. IV morphine patient-controlled analgesia was planned for all patients. All patients' pain (postoperative pain at surgical site and urethral catheter discomfort) scores and total morphine consumption in the recovery unit and during follow-ups on the ward (3, 6, 12, and 24 hours) in the postoperative period were recorded. Results: Sixty-one patients were evaluated. Total tramadol consumption during follow-up on the ward was significantly higher in the non-RSB group. Fentanyl consumption in the postanesthesia care unit was significantly higher in the non-RSB group. Total morphine consumption was significantly lower in the RSB group at 0 to 12 hours and 12 to 24 hours. Total opioid consumption was 8.81 mg in the RSB group and 19.87 mg in the non-RSB group. A statistically significant decrease in urethral catheter pain was noted in the RSB group at all time points.Conclusion:RSB exhibits effective analgesia by significantly reducing postoperative opioid consumption in robotic prostatectomy operations.
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    The role of the size and number of index lesion in the diagnosis of clinically significant prostate cancer in patients with PI-RADS 4 lesions detected by multiparametric MRI of the prostate.
    (Lippincott Williams & Wilkins, 2023) Kılıç, Mert; Madendere, Serdar; Vural, Metin; Köseoğlu, Ersin; Balbay, Mevlana Derya; Esen, Tarık; School of Medicine
    Purpose: To evaluate the contribution of the size and number of the sampled lesions to the diagnosis of clinically significant prostate cancer (CSPC) in patients who had PI-RADS 4 lesions. Methods: In this retrospective study, a total of 159 patients who had PI-RADS 4 lesions and underwent In-bore MRI-Guided prostate biopsy were included. Patients with a lesion classified as Grade Group 2 and above were considered to have CSPC. Univariate and multivariate regression analyses were used to evaluate the factors affecting the diagnosis of prostate cancer (PCa) and CSPC. Results: A great majority (86.8%) of the patients were biopsy-naïve. About three-fourths (71.7%) had PCa, and half (54.1%) had CSPC. When the patients were divided into three groups according to the index lesion size (< 5 mm, 5-10 mm, and > 10 mm), the prevalence of PCa was 64.3, 67.5, and 82.4% and the prevalence of CSPC was 42.9, 51.2, and 64.7%, respectively. In multivariate analysis, age, index lesion size, prostate volume (< 50 ml) and being biopsy-naïve were found significant for PCa, while age and prostate volume (< 50 ml) were significant for CSPC. Conclusion: The number of lesions was found to be insignificant in predicting PCa and CSPC. While the size of PI-RADS 4 lesions was significant in predicting PCa, it had no significance in detecting CSPC.
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    Differential treatment response of prostate and metastatic lesions in patients with newly diagnosed metastatic prostate cancer.
    (Lippincott Williams & Wilkins, 2023) Kılıç, Mert; Bavbek, Sevil; Esen, Barış; Seymen, Hülya; Falay, Fikri Okan; Tarım, Kayhan; Kordan, Yakup; Tilki, Derya; Esen, Tarık; Demirkol, Mehmet Onur; School of Medicine; Koç University Hospital
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    Can the Briganti 2019 nomogram be modified to predict lymph node metastasis risk in patients with prostate cancer detected with in-bore biopsy?
    (Wiley, 2024) Madendere, Serdar; Kılıç, Mert; Vural, Metin; Gürses, Bengi; Armutlu, Ayşe; Kulaç, İbrahim; Tarım, Kayhan; Esen, Barış; Aykanat, İbrahim Can; Veznikli, Mert; Canda, Abdullah Erdem; Balbay, Mevlana Derya; Baydar, Dilek Ertoy; Kordan, Yakup; Esen, Tarık; Koç University RMK Academy of Interventional Medicine, Education, and Simulation (RMK AIMES) / Koç Universitesi RMK İleri Düzey Girişimsel Tıp, Eğitim ve Simülasyon Merkezi (RMK AIMES); School of Medicine; Koç University Hospital
    Objectives: We aimed to modify the Briganti 2019 nomogram and to test whether it is valid for patients who were diagnosed with prostate cancer through in-bore prostate biopsies. Methods: Data for 204 patients with positive multiparametric prostate MRI and prostate cancer identified either by mpMRI-cognitive/software fusion or in-bore biopsy and who underwent robot-assisted radical prostatectomy and extended pelvic lymph node dissection between 2012 and 2023 were retrospectively analyzed. The Briganti 2019 nomogram was applied to the mpMRI-cognitive/software fusion biopsy group (142 patients) in the original form, and then, two modifications were tested for the targeted component. Original and modified scores were compared. These modifications were adapted for the in-bore biopsy group (62 patients). The final histopathologic stage was regarded as the gold standard. Results: Nodal metastases were identified in 18/142 (12.6%) of mpMRI-cognitive/software fusion biopsy patients and 8/62 (12.9%) of the in-bore biopsy patients. In the mpMRI-cognitive/software fusion biopsy group, tumor size/core size (%) of targeted biopsy cores and positive core percentage on systematic biopsy were significant parameters for lymph node metastasis based on univariate logistic regression analyses (p < 0.05). With the modifications of these parameters for the in-bore biopsy group, V1 modification of the Briganti 2019 nomogram provided 100% sensitivity and 31.5% specificity (AUC:0.627), while V2 modification provided 75% sensitivity and 46.3% specificity (AUC:0.645). Conclusions: Briganti 2019 nomogram may be modified by utilizing tumor size/core size (%) for targeted biopsy cores instead of positive core percentage on systematic biopsy or by not taking both parameters into consideration to detect node metastasis risk of patients diagnosed with in-bore biopsies.
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    De-escalation of therapy for prostate cancer
    (American Society of Clinical Oncology, 2024) Yamaoh, Kosj; Esen, Tarık; Esen, Barış; Selek, Uğur; Tilki, Derya; School of Medicine
    Prostate cancer (PCa) is the second most commonly diagnosed cancer in men with around 1.4 million new cases every year. In patients with localized disease, management options include active surveillance (AS), radical prostatectomy (RP; with or without pelvic lymph node dissection), or radiotherapy to the prostate (with or without pelvic irradiation) with or without hormonotherapy. In advanced disease, treatment options include systemic treatment(s) and/or treatment to primary tumour and/or metastasis-directed therapies (MDTs). Specifically, in advanced stage, the current trend is earlier intensification of treatment such as dual or triple combination systemic treatments or adding treatment to primary and MDT to systemic treatment. However, earlier treatment intensification comes with the cost of increased morbidity and mortality resulting from drug-/treatment-related side effects. The main goal is and should be to provide the best possible care and oncologic outcomes with minimum possible side effects. This chapter will explore emerging possibilities to de-escalate treatment in PCa driven by enhanced insights into disease biology and the natural course of PCa such as AS in intermediate-risk disease or salvage versus adjuvant radiotherapy in post-RP patients. Considerations arising from advancements in PCa imaging and technological advancements in surgical and radiation therapy techniques including omitting pelvic lymph node dissection in the era of prostate-specific membrane antigen positron emitting tomography, the potential of MDT to delay/omit systemic treatment in metachronous oligorecurrence, and the efficacy of hypofractionation schemes compared with conventional fractionated radiotherapy will be discussed.
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    Robot-assisted radical prostatectomy: initial results of a single experienced open surgeon in the learning curve
    (Mary Ann Liebert, Inc, 2011) Tefekli, Ahmet; Musaoğlu, Ahmet; Cezayirli, Fatin; Esen, Tarık; Faculty Member; School of Medicine; 50536
    N/A
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    Fluorescence-guided extended pelvic lymphadenectomy during robotic radical prostatectomy
    (Springernature) N/A; N/A; N/A; N/A; N/A; N/A; N/A; N/A; N/A; N/A; N/A; N/A; N/A; N/A; N/A; Özkan, Arif; Köseoğlu, Ersin; Canda, Abdullah Erdem; Çil, Barbaros Erhan; Aykanat, İbrahim Can; Sarıkaya, Ahmet Furkan; Tarım, Kayhan; Armutlu, Ayşe; Kulaç, İbrahim; Barçın, Erinç; Falay, Fikri Okan; Kordan, Yakup; Baydar, Dilek Ertoy; Balbay, Mevlana Derya; Esen, Tarık; Doctor; Faculty Member; Faculty Member; Faculty Member; Doctor; Researcher; Researcher; Teaching Faculty; Faculty Member; Undergraduate Student; Teaching Faculty; Faculty Member; Faculty Member; Faculty Member; Faculty Member; N/A; School of Medicine; School of Medicine; School of Medicine; N/A; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; Koç University Hospital; N/A; N/A; N/A; Koç University Hospital; N/A; N/A; N/A; N/A; N/A; N/A; N/A; N/A; N/A; N/A; N/A; 350876; 116202; 169993; N/A; 327615; 327605; 133567; 170305; N/A; 246484; 157552; 8025; 153320; 50536
    We evaluated and described the impact of prostatic indocyanine green (ICG) injection on extended pelvic lymph node (LN) dissection (ePLND) in robotic-assisted radical prostatectomy (RARP). Between January 2019 and December 2021, we included consecutive 50 PCa patients who underwent ePLND during RARP with (n = 25) or without (n = 25) prostatic ICG injection. ICG injection was performed during abdominal port placement and robot docking. Pelvic LNs reflecting green color were initially excised and then the template was completed. The outcomes of two groups were compared. Overall, nine (36%) and five (20%) of the patients had metastatic LN involvement in the ICG and non-ICG groups, respectively. Of the 509 dissected LNs in the ICG group, 122 (23.9%) were fluorescence active. 20 LNs (3.9%) were metastatic in this group, 9 (45%) of which were ICG+. 408 LNs were resected on the non-ICG group with 8(1.9%) being metastatic. Eight (88.9%) of nine pN+ patients were florescent positive in the ICG group. Out of six patients with pN+ disease, Ga68 PSMA-PET/CT detected positive LNs preoperatively. In addition to preoperative Ga68 PSMA-PET/CT investigation, ICG-guided ePLND might increase identification and removal of metastatic LNs duirng RARP. Improvements in staging and oncologic outcomes may also be seen in intermediate- and high-risk patients.