Üriner Sistem Taş Hastalığı Cerrahi Tedavisinde Minimal İnvaziv Yaklaşımlar III: Laparoskopik ve Robotik Prosedürler
Özet
Teknolojik gelişmelerle birlikte üriner sistem taş hastalığı cerrahi tedavisinde açık cerrahinin yerini Extracorporeal Shock Wave Lithotripsi (ESWL), üreteroskopik litotripsi (URS), perkütan nefrolitotripsi (PNL) ve laparoskopik yaklaşımlar gibi minimal invaziv yöntemler almıştır; günümüzde açık cerrahi oranı %1 düzeyine düşmüştür. Avrupa Üroloji Birliği (EAU) 2022 kılavuzuna göre, laparoskopik ve robotik cerrahi, büyük renal pelvis ve üreter taşlarında, endoürolojik girişimlerin yetersiz kaldığı durumlarda ya da ek böbrek anomalilerinde (atnalı, pelvik böbrek vb.) alternatif ve güvenli bir tedavi seçeneğidir. Laparoskopik piyelolitotomi (LP) ve üreterolitotomi (LÜ), cerrahın deneyimine bağlı olarak transperitoneal veya retroperitoneal yöntemlerle uygulanmakta; açık cerrahiye kıyasla daha iyi kozmetik görünüm, daha az analjezi gereksinimi ve daha kısa hastanede kalış süresi sunmaktadır. Robotik yardımlı laparoskopik yaklaşımlar ise standart laparoskopiye benzer başarı oranlarına ve daha kolay sütürasyon avantajına sahip olmasına rağmen daha maliyetlidir.
With technological advancements, minimal invasive approaches such as Extracorporeal Shock Wave Lithotripsy (ESWL), ureteroscopic lithotripsy (URS), percutaneous nephrolithotomy (PCNL), and laparoscopic approaches have replaced open surgery in the surgical treatment of urinary system stone disease; today, the rate of open surgery has decreased to 1%. According to the European Association of Urology (EAU) 2022 guidelines, laparoscopic and robotic surgery serve as an alternative and safe treatment option for large renal pelvis and ureteral stones, especially when endourological interventions are insufficient or in the presence of additional renal anomalies (such as horseshoe or pelvic kidneys). Laparoscopic pyelolithotomy (LP) and ureterolithotomy (LU) are performed via transperitoneal or retroperitoneal approaches depending on the surgeon's experience, offering advantages over open surgery such as better cosmetic appearance, lower analgesic requirement, and shorter hospital stays. Robotic-assisted laparoscopic approaches share similar success rates with standard laparoscopy and offer the advantage of easier suturing, although they are associated with higher costs.
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