Services

Deals with plastic surgery, aesthetic and reconstructive surgery (renovation surgery). Cosmetic surgery reshapes the normal body structures and develops the appearance of the individual and his perception of himself. Reconstructive surgery is applied on abnormal body structures that were formed in connection with the birth or those that have appeared afterward, and its initial purpose is to recover the functions of the body structures that are affected as much as possible.

Performed Surgical Interference: Reconstruction of the nose by making it smaller or bigger. Nose hump correction, nostril reduction, and nose tip refinement and reshaping. In the meantime, correction of the septum deviations that are available.

ABOUT GYNECOMASTIA SURGERY

(MALE BREAST REDUCTION)

Sustainable Weight Loss in Obesity Treatment: “Bariatric Surgery”

The surgical procedures, which are performed to patients who are unable to lose weight regardless of the treatments administered and of diets and who have a Body Mass Index (BMI) over 40 or over 35 and suffering from chronic diseases, and therefore, to patients who have serious medical problems, are known as “Bariatric Surgery” or “Obesity Surgery”. With obesity surgery, not only patients may get back to their normal weight, but also the prevalence of diseases related to obesity are reduced; that’s why bariatric surgery plays a crucial role in the treatment of obesity. Laparoscopic surgery for obesity shortens the recovery period. The researches on bariatric surgery patients show that patients who have undergone bariatric surgery are less likely to develop the types of cancer linked to obesity when compared to patients who did not undergo bariatric surgery. The reason for this is that while weight loss with dieting and exercise result in 7-10% of weight loss, bariatric surgery ensures 80% of weight loss is supported by necessary lifestyle changes.

In the pre-operative period, eating and drinking habits of patients, diabetes and lifestyle and the status of other health disorders are taken into consideration. Especially, patients between 18 and 60 years of age may undergo this operation. There are several conditions for patients to undergo an operation.

They include:

• Having body mass index over 40 or having body mass index between 35 and 40 and suffering from diseases linked to obesity.
• Suffering from incurable obesity for at least 5 years.
• No change in the course of the disease as a result of drug treatment and dieting.
• Not suffering from endocrine diseases.
• Not suffering from alcohol or drug addiction.
• Complete perception and adaptability and being coordinative with the obesity team in the post-operative period.
• Not having a condition that prevents the surgical operation.

Gastric sleeve surgery is a bariatric operation, during which approximately 80% of the stomach is removed. The weight loss is achieved with more than one mechanism. First of all, the significantly reduced stomach volume leads to less food intake, and therefore, fewer calories.  However, the main effect is not restricting the food intake, but the change it creates on hormones regulating hunger, fullness and blood glucose.

Looking at short-term results, we may say that gastric sleeve surgery, like the older method gastric bypass, is an important surgical operation both for weight loss and for complete treatment of or recovery from metabolic disorders, such as diabetes. Moreover, likewise in gastric bypass, the metabolic effect of gastric sleeve surgery is independent of weight loss. Short after surgical operation, the high blood glucose level is reduced to normal and diabetic drugs or insulin are totally or partially discontinued, even before the weight loss starts. Furthermore, gastric sleeve surgery has less complications, when compared to gastric bypass surgery. The gastric sleeve surgery is favored as it is a restrictive surgery, it ensures the loss 50-60% of body weight easily soon after surgical operation, it does not require change in food passage route in the gastrointestinal system, it shortens the hospitalization period, and it has a positive effect on hormones regulating hunger, fullness and blood glucose.

Gastric bypass surgery is an older operation method in comparison to other bariatric surgery methods. Therefore, it may be deemed as the most used bariatric surgery among others. In the first step of gastric bypass surgery, the stomach is reduced to 30 milliliters. The gastric tissue close to the esophagus and stomach junction is used. The stomach is connected to the small intestine. There are two types of gastric bypass surgery. In the first type, the small intestine is formed in a thin circle and is connected to the stomach. This is called “Mini-gastric bypass”. In the second type of gastric bypass surgery, the small intestine is bypassed and one end is connected to the stomach, while the other end is connected to the small intestine. This method is known as “Roux en Y gastric bypass”. Except for small technical differences, the two methods have similar surgical results. The mechanism in gastric bypass surgery is restrictive as in gastric sleeve surgery, i.e. patient may intake limited amount of food and bile salts and pancreas enzymes found in duodenum meet the nutrients in a distal part of the small intestine. Therefore, the breakdown and absorption of nutrients are rendered difficult and the absorption mechanism is changed. In other words, the patient eats less and gets fewer benefits from nutrients. The change in gastrointestinal hormones is more significant than in gastric sleeve surgery. The patient feels less hungry, even though eating less and blood glucose is regulated. Losing 60-80% of body weight is one of its advantages. The gastric bypass surgery is a food intake restrictive method and it has a more significant effect on gastrointestinal hormones. Also, it is a reversible procedure in comparison with gastric sleeve surgery.

Other operations –duodenal switch- are very specific surgical operations, when we look at the group who underwent an operation or at the rarity of surgical operations; and therefore, patients should be evaluated by the centers.

The most important point for these operations is that patients should know that a new life is waiting for them in the postoperative period. Adopting a low carbohydrate-high protein diet by the guidance of a nutritionist; eating little and often; properly chewing food; getting multivitamins, calcium and vitamin D supports and adding physical exercises are very important. Since patients may feel full with less food, they have no problem to adopt a new lifestyle in the post-operative period

ABOUT THE DEPARTMENT

Memorial Hospital Physiotherapy and Rehabilitation Unit is headed by the team which consists of experienced and successful physiotherapists.

At Memorial Hospital Physiotherapy and Rehabilitation Unit we provide high-quality services in a trustworthy and friendly environment. Our team plans and applies the necessary treatment to relieve the pain and to improve the patient’s condition.

Considering today’s lifestyles and working conditions Physiotherapy and Rehabilitation is a highly important branch. Physiotherapy is used for the rehabilitation of neurological, orthopedic, pediatric, geriatric, gynecological, urogynecological and rheumatologic diseases; to diagnose muscle-skeletal system diseases, and to treat them. After relieving the pain, we provide preventive physiotherapy services to eliminate the cause of the disease.

Various physiotherapy treatment methods are available in our center. Some of them are new treatment methods such as Iontophoresis therapy for the treatment of excessive hand, foot and underarm sweating and biofeedback for the treatment of vaginismus.

VAILABLE REHABILITATIONS IN THE PHYSIOTHERAPY CENTER;

• Orthopedic Rehabilitation
• Neurological Rehabilitation
• Rheumatismal Rehabilitation
• Pediatric Rehabilitation
• Geriatric Rehabilitation
• Cardiovascular Rehabilitation
• Urogenital Rehabilitation
• Ampute Rehabilitation

ABOUT ORTHOPEDICS AND TRAUMATOLOGY PROCEDURES

Knee, shoulder, ankle, wrist, and elbow joint diseases could be treated by arthroscopic surgery in our Arthroscopy Center.

Hip, knee, shoulder and elbow prosthesis to treat calcification related joint defectiveness is being successfully performed in our center.

All kinds of scoliosis, spondylolisthesis and spinal fracture surgeries are being successfully performed in our Spine Surgery Unit.

Bone lengthening and deformity correction surgeries to treat congenital and non-congenital conditions are also being performed in our Center.

Sub-Branches:

• Arthroplasty surgery (joint prostheses)
• Sports Traumatology
• Length extension and leg inequalities
• Pediatric Orthopedics and Traumatology
• Hand surgery and microsurgery
• Knee surgery and arthroscopic surgery
• Shoulder and elbow surgery
• Orthopedic oncology
• Foot and ankle surgery
• Treatment of bone inflammation (osteomyelitis)

Da Vinci Robotic Surgery or also known as robotics is the most advanced technology in the medical world and is especially used in Turkey, especially in major centers in the US, including the departments of urology, gynecology, general surgery, otorhinolaryngology, thoracic surgery, and cardiovascular surgery. The “da Vinci Robot Technology” stands out as a technology with special privileges it provides to the physician and the patient and is today one of the most successful surgical methods used in the fight against cancer all over the world. The robot-assisted laparoscopic surgery method, shortly known as “robotic surgery” has three main characteristics. The first of these is the imaging systems, which work with the principle of laparoscopic surgery. So the image is transferred through the body of the patient to the surgeon with the help of a camera. In contrast to laparoscopic surgery, in robotic surgery this image is three-dimensional and since the camera control is performed by a robot, the image is steady. Clear images can be obtained at a larger magnification by approaching the organ to be operated very closely. The surgeon controls the robot arms using a console. These robot arms are placed in the patient. Fiber optic cables in the console extend to the arms of the robot and transfer the small hand movements made by the surgeon to the robotic arms. Surgical instruments connected to the robotic arms can rotate 540 degrees so that they can move much more than hand movements. In addition, the natural shivering in the hands of a human is not conveyed to the tips of the surgical devices in robotic surgery. In this way, the margin of error is also minimized.

Da Vinci Robotic Surgery in Urological Surgeries

Robotic Surgery was first used in 1994 in the field of cardiovascular surgery. However, the most common usage was in urology surgeries. Since 2001 da Vinci has been used in prostate cancer surgery all over the world; it is also used in kidney, bladder and testicular cancers cases.

The ‘da Vinci Robotic Surgery’ technique is not a purely robot-dependent surgical practice. The experience of the surgical team is the most important factor in the success of the operation, whether it consists of open, laparoscopic or robotic procedures. All urology surgeries are carried out by an experienced team with the methods applied in the most developed centers in the world.

Nerve Protection in Prostate Cancer Center

Following prostate cancer surgery, which is the most common male cancer occurring especially in men over 50 years of age and developed in countries other than skin cancer, sexual dysfunction and urinary incontinence problems, which are the two most important risks negatively affecting the social life of men, can be observed. These risks, which can negatively affect the patient’s quality of life, are minimized in prostate cancer surgeries performed via the “da Vinci Robotic Surgery” technique. The erectile nerves and the urinary retention muscles adjacent to the prostate and leading to the penis are much better protected via robot technology. Thanks to this qualified protection, the risks of urinary incontinence and the risk of penile erectile dysfunction are minimized. With the “Interfacial Nerve Protection” technique applied via robot surgery, the risk of experiencing sexual activity problem after surgery is minimized.

The privileges which the da Vinci also provides to the patient in prostate surgery:

• The length of hospital stay after the da Vinci Robotic surgery is 1 or 2 days. Approximately 95% of the patients have been discharged home on the second postoperative day.
• Only very small blood loss is present during surgery compared to traditional open surgery. Preoperative blood preparation is not required.
• In the hospitalization period and after leaving the hospital, very little pain relief is required. This is because the patients do not feel pain.
• In the first week after surgery (approximately 4 or 6 days later), a catheter is placed into the urethra. In open surgery, this period usually ranges from 14 to 31 days.
• Approximately 90% of patients return to their routine work with or after 3 weeks of operation with da Vinci Robotic Surgery.

Kidney Protective Effect in Kidney Tumor Operations

In kidney tumor surgeries performed via the da Vinci technique, cancer control is provided in the best possible way. Only the tumor tissue is removed and the healthy kidney is left in the patient. Under the three-dimensional and high-resolution enlarged image with robot technology, the tumor is easily removed from the kidney by performing depth calculation in the tissue. The area where the tumor emerges can be sutured quickly and with depth control. After the removal of the tumor tissue, the resulting tissue cavity opened veins and injured urinary channels are repaired extensively and rapidly by using robotic arms. This method can be performed for the removal of the kidney in large-scale kidney cancer.

The privileges which the da Vinci provides to the patient in kidney surgery:

• Hospital stay is short and rapid recovery is achieved.
• Postoperatively, less pain is present and less pain relief medications are used.
• The patient returns to his/her daily activities in a short time.
• The aesthetic appearance does not deteriorate due to the small surgical incisions.
• The surgery is performed with robot arms, with which a steady procedure is achieved.

Vinci Female Nurse PC Ster

Da Vinci S HD System

Testicular Cancer Surgery Via 4 Holes With Robotic Surgery

The closed testicular surgery with da Vinci Robotic Surgery has been successfully applied at Memorial Şişli Hospital. Testicular cancer operations are based on the principle of opening up the abdominal wall between the pelvis, removing the intestines and cleaning the lymph nodes around the large vessels starting from the lower end of the bone called sternum, this can be performed via a few holes completely closed with robot technology. The large incisions required for the open surgery of patients with testicular cancer have become history, thanks to the comfort provided by the robotic surgery that provides the patients with great privileges.

Testicular cancer surgeries performed with Da Vinci Robotic Surgery;

• Pain, infection and wound healing risks in large incisions decrease with robotic surgery.
• The patient’s intestines are not removed as in open surgery. Therefore, the risk of infection and drying up of the intestines is eliminated.
• Some neural structures that have an effect on sexual functions that are located around the aorta or large vessels can be observed more clearly with the robotic surgery technique. These can be protected more effectively. Therefore, fewer problems arise related to semen discharge.
• Since chemotherapy may have long-term side effects, robotic surgery may provide advantages in certain patient groups.
• Difficulties to be experienced in post-operative patients regarding becoming pregnant can be eliminated; sperm obtained from the patient before the operation can be stored in a sperm bank and be used for assisted reproduction techniques.

Artificial Bladder from the Intestine via Da Vinci 

In developed countries; bladder cancer, which is ranking 4th in men and 7th in women, is treated with da Vinci Robotic Surgery without creating a surgical incision on the body. In open bladder cancer operations; at a point starting 4-5 cm above the belly, the bladder and lymph nodes are removed with an incision extending to the pelvic bone, and the bladder made from the intestine is also connected to the normal urinary tract. In addition, patients who have their bladder removed may have problems such as carrying bags continuously in their bellies or using a urethral catheter at regular intervals. In bladder cancer operations performed with da Vinci Robotic Surgery, two different principles are applied. First; After the removal of the bladder and lymph nodes with the robot, the procedure of the new bladder creation from the intestines is performed via an open method and the operation is completed. However, a large incision is required for this surgical technique and since the intestines are taken out of the body, problems such as infection, drying, fluid and heat loss may occur. Bladder cancer operations in the Memorial Şişli Hospital Robotic Surgery Center are performed in a completely closed manner which is a technique used only by very few centers and surgeons around the globe. The operation consists of removal of the bladder, removal of the lymph nodes around the large vessels, bladder reconstruction from the intestines, connection of the urinary canals to this new bladder and the normal urethra connection, after which the surgery is completed in a completely robotic technique.

The privileges provided by the robot in bladder cancer surgery;

• With Da Vinci Robotic Surgery, the patient avoids a very large surgical incision. Surgery can be performed via only 6 holes of 8-15 millimeters each.
• Incision hernias may be observed in open surgery incision, the incision sutures may rupture and another surgery may become necessary; all the complications are eliminated vi da Vinci Robotic Surgery.
• Because of the robotic method, the possibility of bleeding during surgery decreases.
• As the patient is operated without opening up the patient, the risks such as drying of the intestines, infection, and heat loss are significantly reduced.
• After surgery, patients can recover in a shorter time and return to their normal lives.
• In bladder cancer surgery, the bladder and prostate are removed together. This is because, in one-third of patients with bladder cancer, prostate cancer may develop as well while the patients are unaware of this. During extraction of the prostate, the sexual function providing nerves and urine retention mechanisms are better-preserved thanks to the magnification, close-up vision and better illumination of the robot.
• Patients with bladder cancer who undergo surgery with Da Vinci Robotic Surgery; begin to eat on the 2nd and 3rd days post operation. If the bowel movements have become sufficient and if everything goes well, they are discharged in less than a week. At the end of 3 weeks with a catheter, the complete healing of the sutures of the urinary bladder formed from intestines is checked, if healing is complete, the catheter is removed.
• In women, in the case of bladder cancer, the uterus and ovaries are removed as well. Since the uterus is removed from the birth canal, the repair can also be done by the robot during the operation.

Robotic Solution for UPJ Obstruction

Conventional laparoscopic surgery has been an important breakthrough in the surgical treatment of conditions such as renal pain or obstruction of the renal exit (UPJ obstruction) which is detected incidentally at a young age. This surgery is performed with 97% success in laparoscopic procedures. However, with conventional laparoscopy, disadvantages such as millimetric handshaking, two-dimensional images and the limited mobility of the instruments are eliminated thanks to the three-dimensional images, non-shaking robotic arms and perfect movement abilities of the da Vinci Robotic technology.

Role of Robotic Surgery in Urinary Incontinence

In women, especially in cases of urinary incontinence due to sagging of the bladder, even in cases with no incontinence but sagging forward as to be palpable, Vinci Robotic surgery method can be applied. With the robot technology, it is possible to treat the bladder with 100% success and to prevent sagging. Robotic surgery comes into the foreground because it provides the advantage of being able to put fast stitches in the body with the mobility of robotic arms in the sacrocolpopexy operations performed especially in cases called prolapses. Due to the weakening of the sagging ligaments and other supportive tissues, repairing the hanging tissues using synthetic fabrics can be performed for repair purposes, the da Vinci Robotic technology also provides a great advantage in this type of repair.

Da Vince Robotic Surgery in Gynecological Surgeries

In addition to urology and general surgery, da Vinci Robotic Surgery is the most common surgical treatment of gynecological diseases. According to the 2013 data, the number of surgeries performed with robots in female diseases is higher than urology surgeries. Robot technology has brought a new dimension to long-term laparoscopic gynecology surgeries, thanks to the surgeon’s ability to perform a surgery on the console while sitting down.

Outstanding technology success in cancer surgery

Gynecological, uro-gynecologic and oncologic surgeries are among the most difficult surgeries. Robotic surgery is used as the most advanced technology in all gynecologic cancers except advanced stage ovarian cancers. It can be used in all stages of the “endometrium” cancer, also known as uterine cancer and cervix cancers within surgical margins.  Robotic surgery is also used for myomectomy surgeries performed due to infertility and uterine sagging. When the uterine myoma is removed and closed via the laparoscopic method, the risk rupture of the healing area during the next pregnancy may increase due to the failure of the future. However, the risk of stitching is minimal in robotic surgery thanks to its superior sutures. In the later stages of endometriosis, it is difficult to clean them with laparoscopic surgery because the surrounding tissues are very adherent. Robotic surgery is preferred because movements are performed more easily via robots in such surgeries

Technological superiority

Robotic surgery offers many advantages for both the patient and the surgeon thanks to the technological developments and ease of use. The patient stay and recovery time is much shorter than open surgery. Moreover, there are no surgical traces since only some small incisions are made. Robotic surgery provides easy access to the pelvic system. The mobility of the devices used is also very high. The surgical procedure is carried out in an advanced, comfortable and fast way. The surgery is performed more safely because hand vibrations are not conveyed to the robotic arms. Less risk of bleeding is present. The recovery time of the patient is shortened. The risk of infection is lower. The three-dimensional imaging advantage facilitates the surgeon’s work. Since the surgeon works by sitting on a console during the surgery, it is less effortful and does not affect the surgeons concentration.

Da Vinci Robotic Surgery in General Surgery Related Surgeries

Surgeries performed with a small incision “minimally invasive” surgeries are preferred primarily in cancer treatments as is the case in many other areas nowadays. These technologies, which are used today, are considered as the most important development in modern surgery and offer many privileges to patients and physicians in comparison to classical open surgery. Thanks to minimally invasive methods, the most difficult surgeries are performed in a way to provide comfort to the patient due to surgical and technological developments. Laparoscopic surgery compared to open surgery minimizes the length of hospital stay and offers the patient a rapid recovery.

Robotic surgery, which is considered as the most advanced technology in the last 10 years among the minimally invasive surgeries, is being used in general surgery, especially in cancer surgeries. The da Vinci Robotic System is the most advanced surgical technology of our age, controlled by the surgeon, achieving the deepest points during surgery, with a 3-dimensional and clear image, providing multi-angle mobility with robotic arms and without the slightest shaking. The da Vinci Robotic System enters through the small holes opened into the abdominal wall of the abdomen, displaying the deepest organs within the body under 10-fold magnification and in high-resolution with three-dimensional imaging. It enables the surgeon to control the surgery via robotic arms with 7 sizes and thin-small surgical instruments on the tips thereof within the body of the patient.

The “da Vinci Robotic Surgery” provides comfort to the patient

• It does not require a large surgical incision as is the case in open surgery. The process is performed through small holes.
• The surgery is performed with 10 times larger and clearer images.
• The image quality is high resolution and three-dimensional. Thanks to the 3-D image, the depth advantage is ensured.
• It is easy to position with small robotic arms that do not shake and move at 720 degrees.
• The presence of vessels and nerves is clearly imaged.
• It is a more successful method compared to open surgery in tumor operations.
• Bowel activities return to pre-op conditions much faster.
• The nutrition of the patient returns to normal faster than in open surgery.
• The risk of infection at the surgical site is low.

Robotic Technology in Cancer Surgery

Upper Gastrointestinal System

The da Vinci Robotic System, which has been developing rapidly all over the world since 2001, is becoming increasingly popular nowadays. Interventions can be performed more conveniently and safely with superior tissue separation suturing techniques of the da Vinci Robotic System for upper gastrointestinal surgery.

• GERD (Reflux Surgery)
• Hiatal Hernia
• Stomach and Stomach Cancer
• Achalasia (Esophagus lower tip narrowness)

Small Intestine Surgeries

Use of Robotic System; It is important because of the procedures applied to the patient and the ability of the surgeon to facilitate their interventions. It enables the surgeon to perform thinner tissue separations and more comfortable sutures by providing more detailed monitoring of vessels and nerves. It provides the opportunity to adhere to the principles of cancer surgery. It facilitates the approach to the tissue by providing 3D (three-dimensional) appearance, with more features than laparoscopic cameras. This enables the surgeon to see more and move more in areas that are difficult in open surgeries.

• The narrowness of small intestine (due to Crohn’s disease)
• Small intestine tumors

Colorectal Surgery

The Robotic System starts with the form of laparoscopy surgery and used at the stage where superior dexterity comes into use. In this method, no incision the size of a hand is required, neither is hand supported surgery required.

The privileges provided to the patient;

– Better clinical data on cancer control in many cases,

– Faster improvement in intestinal function,

– Faster transition to normal nutrition

– Significantly less pain,

– Lower blood loss, lower risk of wound infection,

– Shorter hospital stay,

– It provides shorter recovery time.

Robotic System In colorectal surgery;

used in colon cancer, rectum cancer, and prolapse surgeries.

HPB (LIVER-PANCREAS-BILE TRACT) SURGERY

Instead of the open surgical method for repair, especially in biliary tract injuries, the da Vinci Robotic System is able to perform repair more precisely and without major incisions.

• Neuroendocrine Surgery
• Pancreas body, tail cyst, and tumors
• Spleen Protective Surgery
• Gallbladder and Bile Tract Surgeries
• Spleen Surgeries

Laparoscopic and Robotic Surgery in Pancreas Cancer Surgery 

Pancreatic cancer is the most dangerous cancer in intra-abdominal cancers. The frequency is increasing and in recent years, quite extensive studies are carried out. It is the location of the organ that makes pancreatic cancer more important than other types of cancer. The pancreas, which plays a very important role in the body, is difficult to intervene surgically. Therefore, the term “untouchable” is usually used for the pancreas.

Pancreatic Cancer Treatment Process

If the patient is diagnosed with pancreatic cancer via MRI or tomography, a biopsy should be performed to determine if the diagnosis is definite. If a mass is detected and the patient has complaints such as jaundice and weight loss, the diagnosis is probably correct. An endoscopic biopsy may be necessary in suspected cases. The most important stage of treatment is surgery. Whether the patient’s tumor will be surgically removed is determined by staging. If no metastasis is present in the liver or other organs and the involvement of large vessels is not severe, the patient is operated first. Additional treatments are planned according to the patient’s condition after the surgery. In patients with no chance of surgery, chemotherapy is administered first. In the case of regression of the tumor with drug treatments, it is reassessed whether the patient can be a candidate for surgery. In the case of metastasis of pancreatic cancer to many foci and distant organs in the body, first of all, chemotherapy and then alternative treatment options are discussed. The most important point that should not be considered in pancreatic cancer is that the behavior of the tumor varies from person to person as is the case in every cancer type. Therefore, each patient has a chance of treatment and these options should be investigated.

Current Surgeries in Pancreatic Cancer Surgery

In recent years, the most important development in pancreatic cancer surgery is the use of minimally invasive methods, these being laparoscopic and robotic surgeries. The laparoscopic surgery is also performed in patients with pancreatic cancer by entering through a few holes with special tools without causing a large incision on the body.  Laparoscopic surgery; if the location of the pancreas tumor is in the trunk or tail, this surgery modality should be primarily considered. In pancreatic head tumors, if the tumor is detected at an early stage, there is no uptake in the main vein and the patient’s age is appropriate, laparoscopic surgery can be performed.

In pancreatic cancers, robotic surgery provides the following important privileges to the patient and the physician;

• Robotic surgery offers the advantages of open surgery and laparoscopic procedures.
• With robotic surgery, cancer can be better controlled.
• It decreases the risk of infection during the surgery and increases the chance of survival of the patient as it does not cause major surgical incisions on the body.
• During surgery, vessels, lymph nodes, and other formations are better displayed, which increases the chance of surgery.
• The spleen can be protected during surgery.
• After surgery, the intestines begin to work earlier, the patient feels less pain than in open surgeries, the patient can be discharged from the hospital in a shorter time and will recover and return to normal life faster. The absence of incisions or large scars on the body provides a better cosmetic result to the patient.

Treatment Alternatives in Metastatic Pancreatic Cancers

Pancreatic cancer most frequently metastasizes to the liver. Patients with this type of disease usually display late symptoms, the tumor is located in the trunk and tail of the pancreas. Surgery should not be considered as a treatment option to provide rapid response to the patient. Only patients whose biopsy results or radiological images have been identified as neuroendocrine tumors can be treated and treated quickly. The treatment for patients with metastatic pancreatic cancer is chemotherapy. However, chemotherapy treatment should also be performed after the patient’s condition has been evaluated and the response is predicted.

Robotic Bariatric Surgery-Obesity Surgery:

The global use of the da Vinci Robotic Surgery technology laparoscopically and use thereof in obesity surgeries as well as providing special benefits to the physician the patient.  Since the anatomical structures of obesity patients, the extra precision required in such operations can be achieved with the ability to move the arms of the robot with great dexterity in the abdomen of the patient. Robotic technology, which provides the surgeon with a three-dimensional and high-resolution image, allows the protection of organs, tissues, and nerves adjacent to the region where the procedure is performed. In some patients, procedures that can be performed with few or a single hole without creating a surgical incision eliminate the aesthetic concerns of patients.

Tubular gastric surgery and gastric bypass operations are performed successfully by using robot technology in obesity surgeries.

The privileges of the robot technology for the patient and the physician can be listed as follows:

• Since the surgery is performed with a closed technique and through only a few holes, the risk of infection as is present in open surgery is eliminated.
• The surgeon performs the surgery with a 3-dimensional and digital appearance thanks to the robot technology with an opportunity to protect the nerve, blood vessels, muscles and tissues of the patient and decreased likelihood of injury.
• Thanks to robot technology, no surgical incision are required on the patient’s body. Since the procedure is performed through several holes rather than a single large incision, the patient faces much less risk of infection and has a comfortable recovery time with less pain.
• Since the patient’s time of stay till discharge, return to daily life and recovery time is shortened, pain control is provided, the patient is fed orally earlier on and recovers the body resistance in a shorter time.
• Once the patient reaches the quality of daily life, he/she is able to return to work and social life faster.

Robotic Surgery for Ear Nose Throat Diseases 

The use of robotic surgery in ear, nose, throat and head-neck-surgery provides great advantages for patients. It is used in many ear, nose and throat diseases such as benign tumors and cysts which are located in the larynx, pharynx, tonsils, tongue, and mouth. The da Vinci robotic surgery provides a comfortable and safe post-operation period for the patients and enables them to return to their normal social life in a short duration.

How is robotic surgery used in ear nose throat surgery?

Robotic surgery is a technique and technology with the past 10 years. Surgical treatment of ear nose throat problems has been used around the globe and in our country since 2010.

The da Vinci surgical system in general surgery and urology departments is used for surgeries such as abdominal surgeries via robot arms that enter the abdomen through holes on the skin of the abdomen. Otorhinolaryngology operations are performed by entering the oral cavity without any hole or incision. Therefore, in defining this surgical method, the term “Trans-oral Robotic Surgery“ which means ”Through the mouth”.

The da Vinci and trans-oral robotic surgeries are performed with instruments connected to robotic arms. These surgeries are carried out under three dimensional and 16 times enlarged endoscopic images using precision control systems with very small instruments that have the skill and sensitivity that the human hand cannot achieve.

Dependent on the disease on which surgical intervention will be performed, in surgeries performed through the mouth thinner and smaller instruments are utilized than in other robotic surgeries When the human hand is compared to the da Vinci robot; the fact that it eliminates the risk of shaking and has much more movement angles creates the opportunity to perform minimally invasive surgical procedures by protecting the healthy tissues and functions without damaging the vessel – nerve structures.

Hangi kulak burun boğaz hastalıklarında da Vinci robotik cerrahi kullanılmaktadır?

• Bademciklerin iyi ve kötü huylu tümörleri
• Dil kökünün iyi ve kötü huylu tümörleri
• Geniz, yumuşak damak, yanak, yutak, bölgesinin iyi ve kötü huylu tümörleri
• Gırtlağın iyi huylu ve kötü huylu tümörleri, kistleri ve kanserleri.
• Uyku apnesi sendromu ve horlamanın cerrahi tedavisinde kullanılabilmektedir.

İleri uyku apnesi olgularında robotik cerrahi uygulamasıyla hasaların CRAP cihazı kullanmaktan kurtulabilmektedir.

Ayrıca aşırı büyük dil (makroglossi) varlığında robotik cerrahiyle dil küçültme işlem tecrübeli ellerde gerçekleştirilebilmektedir.

Kulak burun boğaz ameliyatlarında robotik cerrahinin klasik açık cerrahiyle yapılan ameliyatlara avantajları nelerdir?

Kulak burun boğaz ve baş boyun cerrahisinin klasik ameliyatlarında boyun bölgesinde, yüzde ve çene kemiğinde büyük kesikler yapılarak işlemler gerçekleştirilir. Bu operasyonlar da Vinci robotik cerrahi yöntemi ile ağız yolundan yapıldığından ciltte herhangi bir kesi yapılmadan tamamlanır ve hastanın iyileşme süreci çok daha hızlı olur. Bütün bu işlemler hastalarda daha az kanama, daha az ameliyat yara izi oluşumu, daha az enfeksiyon riski yaratır. Hastaların hastanede kalış süresi kısalır ve hastalar daha kısa sürede normal beslenmeye ve konuşmaya geçer.

• Ameliyat kesi yerinin olmaması,
• Ağrı hissinin daha az olması
• Kanamanın daha az olması ve kan nakli ihtiyacının azalması
• Ameliyat cilt yarası olmaması nedeniyle yara yeri enfeksiyonunun olmaması,
• Günlük yaşantıya çok kısa sürede dönülmesi
• Trakeotomi ismi verilen boğaz’a delik açılması işlemine gerek duyulmaması,
• İyileşmenin hızlı olması,

What are the advantages of robotic surgery to endoscopic surgery?

• The robot has more mobility than the 5 mm wrist and the wrist mimicking tips reach the most remote locations and allow the surgical procedure to be performed.
• The ends of the robot can move 540 degrees on 7 planes. Endoscopic instruments can move in one plane.
• The robot eliminates handshaking. In robotic surgery, the surgeon’s hand does not shake. In endoscopic surgery, shaking is a very serious problem.
• Tools may become curled and bent. Endoscopic instruments are rigid, cannot be bent.
• Sutures can be performed in robotic surgery. While in endoscopic surgery this is not the case.
• Robotic surgery provides a 3-dimensional view. Endoscopic surgery provides a 2-dimensional view
• In robotic surgery, the surgical area is magnified 16 times. Magnification is not possible with endoscopes.
• In endoscopic surgery, the surgeon can only utilize one hand since one hand is occupied holding the endoscope. In robotic surgery, the surgeon can use both hands in the surgical area. In addition, both hands of the surgeon can help with procedures at the surgical site. This enables the possibility of sutures and 4 procedures on the same site. While the surgery durations are shortened, procedures that cannot be performed in endoscopic surgery can be performed via robotic surgery.

How is the da Vinci robotic surgery utilized in sleep apnea surgeries?

One of the newest uses of robotic surgery is obstructive sleep apnea syndrome. In obstructive sleep apnea, some levels of the upper respiratory tract become obstructed during sleep. With known methods, surgery is performed on the soft palate, tonsils and small tongue. However, these methods are not sufficient in more than half of the patients. In most of the obstructive sleep apnea patients, obstruction is observed at the tongue base and at the level of the flap above the epiglottis.

With previously known methods, the root of the tongue and flap above the larynx could not be approached without an incision. However, robotic surgery can be performed easily without a neck incision in this region.  A multi-level surgery is performed in patients with obstructive sleep apnea via robotic surgery and all obstructions can be cleared. Patients who have to use sleep breathing apparatus such as CPAP are provided with the comfort of devices less sleep.

How is robotic surgery utilized in throat cancer surgery

One of the areas where robotic surgery is used is laryngeal cancer. Robotic surgery is advantageously used in early-stage patients where the upper part of the throat and the vocal cords are involved. Throat cancer surgery is performed via robotic surgery without opening a hole in the throat, no wound occurs on the neck.

The patient recovers in a shorter period of time and starts to talk and regains the ability to swallow much earlier. Robotic surgery can be used safely in early-stage tumors of the larynx

About Cardiovascular Surgery

Thanks to the innovations in dental medicine such as dental implants, porcelain veneers, and tooth whitening treatments, it is now possible to achieve a beautiful smile and asymmetric, balanced face.

Dental treatments are easily performed by experienced dental surgeons under general anesthesia to meet the surgical needs of especially mentally retarded patients, orthopedically handicapped patients, elderly patients, children and those who either feel an extreme fear of dental therapies or desire to have the therapy done in a short time.

Laugh Design

If you are dissatisfied with your smile, you can see the procedures to be done to your teeth in advance with the help of a computer. With the help of cosmetic imaging programs, you can have an idea of the smile you will have after the process by transferring your photos taken before the process to the computer without processing your teeth.

Whitening

Teeth whitening can be done by brushing the teeth or cleaning the teeth with superficial cleaning procedures, resulting from the structure of the teeth and leading to bad appearance, teeth whitening (bleaching) method can not be removed. The Teeth Whitening System, which provides permanent cleaning without damaging your teeth, is now at Memorial Hospital!

This new system, implemented with Light Emitting Diode (LED) light source and special whitening gel, is the product of very advanced technology. Since the rate of hydrogen perolmite, which is 38% in the bleaching system applied so far, has been reduced by 15%, the success rate of elimination of sensitivity after the application has been drawn to very high levels.
With the whitening system, you can achieve an average of 8 times more white teeth.
Fast-applied in three circuits of 20 minutes, this professional system gives you crisp white teeth in 1 hour in your comfortable seat.
Reliable-proven by clinical trials in America, the whitening system does not damage tooth enamel and fillings. It’s also completely painless.
Laminate Veneers

The completion of this procedure is approximately three stages.

1. In the first appointment, you will work on the Smile Design you want to have, and the computer-aided Smile Design will be selected from among the many laughs that suit you and decide which smile you want to have.

2. The next time you visit, your teeth will be shaped and made up of models, and at this stage, they will be tried in your mouth to decide if they are appropriate.

3. On your last visit, porcelain veneers with the color set are glued.

Porcelain laminate veneers are the most effective and most conservative method to change tooth color, size, and shape. They are glued to the front tooth surface to mask bad coloration or change the shape of the tooth and are resistant to recolonization.

Porcelain laminate veneers are very thin porcelain leaves and are glued to the front faces of the teeth in a process called bonding. This procedure is like a false nail. It is a conservative and harmless procedure, as their thickness is no more than the thickness of a lens and there is very little etching from the tooth surface.

To change your smile and make it more pleasant, laminate veneers can be an ideal solution for you. This procedure, which does not even require anesthesia, can be an alternative solution to have whiter teeth, to turn off colorations, to make your smile better. It also shows high resistance to coffee, tea, and even cigarette colorings after they are done, and does not recolonize. It is aesthetically superior in comparison to other restorative options.

ABOUT EYE SURGERY PROCEDURES

Machine-driven and manual devices such as auto refractor keratometer, air puff, and applanation tonometer (for the measurement of intraocular pressure), direct and indirect ophthalmoscope are being used in our center; and patient records are saved in our computer database.

Every single ophthalmology is performed by experienced surgeons using the latest technology and devices. Almost 100% of the cataract surgeries are being performed under drop anesthesia using the Phacoemulsification Technique that does not require stitches. All kinds of complicated vitreoretinal surgeries are successfully performed including pars plana vitrectomy ( to treat vision loss due to diabetes), internal limiting membrane peeling, foveal translocation surgery for macular degeneration due to senior age are being performed with great success.

Cornea transplants are performed using donor corneas attained from Eye Banks.

Glaucoma (eye tension), cross-eyed vision and retina decollement surgeries are carried out using the most appropriate methods.

Excimer Laser applications performed for the correction of myopic, astigmatic and hypermetropic vision are being carried out using the LASIK method and drop anesthesia.

EXCIMER LASER

25 years ago, the idea of treating the refractive errors by changing the declivity of the cornea, improved the scratch surgeries of Fyodorov. The procedure to treat myopia was relying on flattening the cornea by scratching it with diamond blades. Comparative satisfaction achieved with this technique forced scientists to search for better techniques.

20 years ago, researchers found out that excimer laser can create an ablation (destruction of the tissue by so to say vaporizing it) of 0,25-micron thickness. Thanks to improvements of the technique; excimer laser is now very consistent and reliable. For about 15 years refractive errors are being treated with excimer laser all over the world as well as in our country.

Every single laser pulse embraces the ligaments between the corneal cells. The sensitivity of this procedure is up to 0,25-micron thickness. In excimer laser technology, the laser beam ablates (in desired thickness and width) the targeted tissue. Thus, refractivity of the eye changes as desired. This technique does not scratch the eye, therefore pressure alterations do not jeopardize the integrity of the eye. Since the laser only influences some specific areas of the cornea, it does not harm the optic center.

Operations were used to be performed using a technique called PRK; however, today’s medical sciences prefer Lasik or Lasek depending on the condition of the eye

LASIK

This technique is being used since 1994. Lasik excimer laser is used for cutting a flap in the cornea and folding it back. Thanks to this technique, pain after the surgery decreased a lot. The patients reach an adequate vision level the very next day. Even high refractive errors might be treated with LASIk. No distinctive stain occurs in the cornea. It is very rare for the refractive error to redevelop after the LASIK surgery. The stabilization is completed within a month. If the patient still needs glasses after a month, a second LASIK surgery might be performed by simply folding the existent flap. In suitable eyes, LASIK surgery shows satisfactory results with up to +6,00 hypermetropia and up to -12,00 myopia treatment.

The purpose of refractive surgery is to minimize or to exterminate the refractive error if possible. If the patient can see without eyeglasses ( as good as he/she sees with them) after the surgery then it is considered a successful result. The excimer laser is a FDA approved technology and millions of people were treated with it. Lasik is performed under drop anesthesia. Eyelids are wide open with the aid of a tool so that the patient does not blink. After marking the center of the cornea, a microkeratome that will create the flop is disposed into the eye. While preparing the flap, the sensation of light disappears for 3 to 4 seconds because of the pressure which was created by the keraton. Laser treatment does not last more than a minute.  The procedure ends with an antibiotic drop after the eye is carefully cleaned and the flop is folded back. The first day, the eye may burns, itches or feels like there is something in it, but it should not give any discomfort the next day. It is very important that no wrinkle occurs on the flap after the surgery. Therefore the eye should not be rubbed for a month (most importantly the first days). If wrinkle occurs, the flap should be folded back by the physician.

LASEK

It is performed on patients whom corneas are not thick enough for the LASIK. This procedure is also performed under drop anesthesia. The patient does not feel any pain during the laser procedure. The front layer of the cornea is lifted then the laser is performed. After the laser is performed, the layer of the cornea is folded back and a contact lens is disposed on the top of it. The contact lens stays on until this layer heals itself. The first couple of days, the eye may burns, itches or feels like there is something in it. With this technique, the vision starts improving the next day however it takes longer to recover (3 to 4 weeks) then the LASIK.

SOME OF THE DEVICES WE HAVE IN OUR OPHTHALMOLOGY

TOPCON COMPU VISION EYE EXAMINATION SYSTEMS