{"id":10080,"date":"2021-03-15T17:43:19","date_gmt":"2021-03-15T14:43:19","guid":{"rendered":"http:\/\/blog.ulubat.org\/?p=10080"},"modified":"2021-03-15T17:43:21","modified_gmt":"2021-03-15T14:43:21","slug":"minimal-invaziv-cerrahi-her-zaman-en-iyi-secenek-mi","status":"publish","type":"post","link":"https:\/\/blog.ulubat.org\/index.php\/genel\/minimal-invaziv-cerrahi-her-zaman-en-iyi-secenek-mi\/","title":{"rendered":"M\u0130N\u0130MAL \u0130NVAZ\u0130V CERRAH\u0130: HER ZAMAN EN \u0130Y\u0130 SE\u00c7ENEK M\u0130?"},"content":{"rendered":"\n

G\u00fcn\u00fcm\u00fczde t\u0131bb\u0131n her alan\u0131 gibi cerrahide de yeni y\u00f6ntemler geli\u015ftirme \u00e7abalar\u0131 h\u0131z kesmeden devam ediyor. Son y\u0131llarda; ufak kesi alanlar\u0131 arac\u0131l\u0131\u011f\u0131yla hastan\u0131n i\u00e7ini kamera ile g\u00f6rerek ger\u00e7ekle\u015ftirilen robotik ve laparoskopik cerrahiler, eskinin b\u00fcy\u00fck yara izleri ile hemen kendini belli eden a\u00e7\u0131k operasyonlar\u0131n\u0131n taht\u0131n\u0131 sall\u0131yor.\u00a0 Peki bu minimal invaziv olarak adland\u0131r\u0131lan cerrahiler her zaman a\u00e7\u0131k cerrahiden daha m\u0131 iyidir? \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/p>\n\n\n\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Minimal invaziv cerrahi tekniklerini hasta a\u00e7\u0131s\u0131ndan daha tercih edilebilir k\u0131lan bir\u00e7ok fakt\u00f6r bulunmakta. \u00d6rne\u011fin \u00e7ok daha ufak bir yara izi, buna ba\u011fl\u0131 olarak enfeksiyon riskinin azalmas\u0131 ve hastanede kal\u0131\u015f s\u00fcresinin k\u0131salmas\u0131 gibi durumlar s\u00f6z konusu. Bunun yan\u0131nda operasyon esnas\u0131nda daha az kan kayb\u0131 ve ard\u0131ndan hastay\u0131 rahats\u0131z edecek olan a\u011fr\u0131n\u0131n azl\u0131\u011f\u0131 bu operasyonlar\u0131 olduk\u00e7a cazip k\u0131l\u0131yor.<\/p>\n\n\n\n

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commons.wikimedia.org<\/figcaption><\/figure>\n\n\n\n

Robotik cerrahi, laparoskopinin de sa\u011flad\u0131\u011f\u0131 sayd\u0131\u011f\u0131m\u0131z bu avantajlar\u0131n yan\u0131 s\u0131ra 3 boyutlu bir g\u00f6r\u00fcnt\u00fc \u00fczerinden cerrah\u0131n operasyonu ger\u00e7ekle\u015ftirmesini sa\u011fl\u0131yor. Kullan\u0131lan enstr\u00fcmanlar\u0131n sa\u011flad\u0131\u011f\u0131 y\u00fcksek rotasyon ve artik\u00fclasyon kabiliyeti ve robot sisteminin fizyolojik tremoru ortadan kald\u0131rarak ameliyat\u0131 daha g\u00fcvenli hale getirmesi de robotik cerrahinin sa\u011flad\u0131\u011f\u0131 kolayl\u0131klar aras\u0131nda.<\/p>\n\n\n\n

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commons.wikimedia.org<\/figcaption><\/figure>\n\n\n\n

Bu kadar olumlu \u00f6zelli\u011finden bahsettikten sonra akl\u0131n\u0131za bu operasyonlar\u0131n hi\u00e7 mi olumsuz bir y\u00f6n\u00fc yok sorusu gelmi\u015f olabilir. Tabi her \u015fey bu kadar toz pembe de\u011fil. Hala baz\u0131 operasyonlarda cerrah\u0131n daha geni\u015f bir g\u00f6r\u00fcnt\u00fc ve m\u00fcdahale alan\u0131na ihtiyac\u0131 olmakta. Minimal invaziv operasyonlar her ne kadar daha teknolojik y\u00f6ntemlerle uygulansa da operasyon s\u00fcresinin artmas\u0131na, buna ba\u011fl\u0131 olarak da gereken anestezi s\u00fcresinin uzamas\u0131na sebep oluyor ve bu baz\u0131 hastalar i\u00e7in ciddi s\u0131k\u0131nt\u0131lara yol a\u00e7abiliyor.<\/p>\n\n\n\n

Robotik cerrahide, hala taktil feedback\u2019in yani cerrrah\u0131n ne kadar bas\u0131n\u00e7 uygulad\u0131\u011f\u0131n\u0131 fark edebilece\u011fi bir geri bildirim sisteminin olmay\u0131\u015f\u0131 ve robotik cerrahi sistemlerinin milyon dolarlar\u0131 a\u015fan masraflar\u0131 baz\u0131 durumlarda bu sistemleri geri plana itiyor.<\/p>\n\n\n\n

Pratik uygulama s\u00f6z konusu oldu\u011funda, hangi operasyonda hangi y\u00f6ntemi se\u00e7ece\u011fimiz karar\u0131 yukar\u0131da s\u00f6z etti\u011fimiz fayda- zarar listesine bakarak verilecek kadar kolay bir karar de\u011fil maalesef ki. Bunun en \u00e7arp\u0131c\u0131 \u00f6rne\u011fi 2018\u2019in kas\u0131m ay\u0131nda t\u0131p d\u00fcnyas\u0131n\u0131n en prestijli dergilerinden olan NEJM\u2019de ( New England Journal of Medicine) yay\u0131nlanan “Minimally \u0130nvasive versus Abdominal Radical Hysterectomy for Cervical Cancer” isimli bir makale. Bu makalede yazarlar erken evre serviks(rahim a\u011fz\u0131) kanseri hastalar\u0131nda ger\u00e7ekle\u015ftirilen radikal histerektomi operasyonunun minimal invaziv ve a\u00e7\u0131k uygulamalar\u0131 aras\u0131ndaki sonu\u00e7 farklar\u0131n\u0131 prospektif yani ileriye d\u00f6n\u00fck \u00e7ok merkezli randomize bir \u00e7al\u0131\u015fmayla ortaya koymay\u0131 ama\u00e7lam\u0131\u015flar. Bu zamana kadar y\u00fcr\u00fct\u00fclen retrospektif yani geriye d\u00f6n\u00fck \u00e7al\u0131\u015fmalar hastal\u0131ks\u0131z sa\u011f kal\u0131m\u0131n ve total sa\u011f kal\u0131m\u0131n iki operasyon t\u00fcr\u00fc aras\u0131nda anlaml\u0131 fark g\u00f6stermedi\u011fini ortaya koysa da istatistiksel anlamda daha de\u011ferli olan bu prospektif \u00e7al\u0131\u015fma bu iki de\u011ferde de minimal invaziv cerrahinin geride kald\u0131\u011f\u0131n\u0131 ortaya koymu\u015f hatta ortaya \u00e7\u0131kan de\u011ferler o kadar radikal farklar i\u00e7eriyormu\u015f ki \u00e7al\u0131\u015fma ani bir kararla durdurulmu\u015f.Ara\u015ft\u0131rmac\u0131lar\u0131 pani\u011fe sevk eden \u015fa\u015f\u0131rt\u0131c\u0131 say\u0131lar \u015fu \u015fekilde:<\/p>\n\n\n\n

Hastal\u0131\u011f\u0131 tekrar eden 34 hastadan 27\u2019si minimal invaziv y\u00f6ntemlerle opere olmu\u015f.<\/p>\n\n\n\n

Ameliyat sonras\u0131 takip d\u00f6neminde g\u00f6r\u00fclen 22 \u00f6l\u00fcm\u00fcn 19\u2019u yine minimal invaziv y\u00f6ntemlerle opere olmu\u015f.<\/p>\n\n\n\n

Ortaya \u00e7\u0131kan bu \u015fa\u015f\u0131rt\u0131c\u0131 durumun nedenleri ile ilgili bu ara\u015ft\u0131rma kapsam\u0131nda bir \u00e7al\u0131\u015fma yap\u0131lmam\u0131\u015f olsa da minimal invaziv tekniklerde kullan\u0131lan rahim manip\u00fclat\u00f6r\u00fcn\u00fcn t\u00fcm\u00f6r yay\u0131lmas\u0131n\u0131 artt\u0131rabilece\u011fi ve bu operasyonlarda kullan\u0131lan CO2\u2019nin de bu duruma katk\u0131 sa\u011flayabilece\u011fi fikirleri ortaya at\u0131lm\u0131\u015f. <\/p>\n\n\n\n

Bu ara\u015ft\u0131rma ile birlikte jinekoonkoloji ba\u015fta olmak \u00fczere bir\u00e7ok alanda minimal invaziv cerrahi her zaman iyi bir se\u00e7enek mi konusundaki soru i\u015fareti cerrahlar\u0131n ve ara\u015ft\u0131rmac\u0131lar\u0131n kafas\u0131nda iyiden iyiye belirmi\u015f oldu. Baz\u0131 y\u00f6ntemler ka\u011f\u0131t \u00fczerinde her ne kadar daha avantajl\u0131 g\u00f6r\u00fcnse de prati\u011fe ge\u00e7irildi\u011finde sonu\u00e7 her zaman b\u00f6yle olmayabiliyor. Bu ara\u015ft\u0131rman\u0131n da bizlere g\u00f6sterdi\u011fi \u00fczere ortaya \u00e7\u0131kan yenilik\u00e7i tan\u0131\/tedavi yakla\u015f\u0131mlar\u0131 klini\u011fe aktar\u0131l\u0131rken prospektif randomize \u00e7al\u0131\u015fmalarla etkinli\u011finin test edilmesi b\u00fcy\u00fck \u00f6nem arz ediyor.<\/p>\n\n\n\n

KAYNAK\u00c7A<\/h3>\n\n\n\n

Health, B. (2017, March 31). Exploring surgery options: Open vs. minimally invazive. Retrieved March 13, 2021, from https:\/\/www.beaumont.org\/health-wellness\/blogs\/exploring-surgery-options-open-vs-minimally-invazive#:~:text=%E2%80%9CMinimally%20invazive%20surgery%20requires%20a,Lewis<\/a>.<\/p>\n\n\n\n

McMacken, M. (2017, June 21). Types of minimally invazive SURGERY (Robotic, Endoscopic, LAPAROSCOPIC): Johns hopkins medicine in Baltimore, MD. Retrieved March 13, 2021, from https:\/\/www.hopkinsmedicine.org\/minimally_invazive_robotic_surgery\/types.html<\/a><\/p>\n\n\n\n

Jennifer Whitlock, R. (n.d.). The difference between open and minimally invazive surgery. Retrieved March 13, 2021, from https:\/\/www.verywellhealth.com\/open-surgery-3157124<\/p>\n\n\n\n

Ramirez, P. T., Frumovitz, M., Pareja, R., Lopez, A., Vieira, M., Ribeiro, R., Buda, A., Yan, X., Shuzhong, Y., Chetty, N., Isla, D., Tamura, M., Zhu, T., Robledo, K. P., Gebski, V., Asher, R., Behan, V., Nicklin, J. L., Coleman, R. L., & Obermair, A. (2018). Minimally \u0130nvazive versus Abdominal Radical Hysterectomy for Cervical Cancer. The New England journal of medicine<\/em>, 379<\/em>(20), 1895\u20131904. https:\/\/doi.org\/10.1056\/NEJMoa1806395<\/p>\n","protected":false},"excerpt":{"rendered":"

G\u00fcn\u00fcm\u00fczde t\u0131bb\u0131n her alan\u0131 gibi cerrahide de yeni y\u00f6ntemler geli\u015ftirme \u00e7abalar\u0131 h\u0131z kesmeden devam ediyor. Son y\u0131llarda; ufak kesi alanlar\u0131<\/p>\n","protected":false},"author":390,"featured_media":10082,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[1,25,20,165],"tags":[135,1923,1926,1925,1878,1927,1924],"acf":[],"views":524,"_links":{"self":[{"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/posts\/10080"}],"collection":[{"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/users\/390"}],"replies":[{"embeddable":true,"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/comments?post=10080"}],"version-history":[{"count":3,"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/posts\/10080\/revisions"}],"predecessor-version":[{"id":10086,"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/posts\/10080\/revisions\/10086"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/media\/10082"}],"wp:attachment":[{"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/media?parent=10080"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/categories?post=10080"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/tags?post=10080"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}