Liv Hospital
ADVANCED LAPAROSCOPIC AND ROBOTIC SURGERY CENTER
TURKEY
As the second largest cause of death in Turkey and around the world after cardiovascular disease, cancer can seem a fearful prospect for all of us. However, it is now possible to obtain successful results through early diagnosis. The most important thing is to get the cancer diagnosed as early as possible, through periodic check-ups. Cancer case evaluation at Liv Hospital is based on a multidisciplinary philosophy and carried out meticulously by specialists in a range of disciplines. The appropriate treatment protocol is implemented in line with a joint decision, ensuring a holistic approach to patients. There is a high level of emphasis on quality intensive care support at Liv Hospital’s center of specialized surgery. Thanks to the high level of specialist experience and competence, top-tier intensive care support and high technology, the patient can be safely discharged in the shortest possible time. Liv Hospital has a wide repertoire of diagnosis, surgery, treatment and follow-up processes, as well as the most advanced medical and technologic equipment; all your requirements will be met, from early cancer diagnosis to a personalized treatment plan, including cancer prevention measures and psychological support.
Take a step forward for yourself, take preventive measures‌
CONTENTS ADVANCED LAPAROSCOPIC AND ROBOTIC SURGERY • What is advanced laparoscopic and robotic surgery? • How safe is it? • What are the advantages? AREAS OF APPLICATION 1 - CANCER SURGERY General Surgery • Colorectal cancers • Pancreatic cancer • Liver cancer • Esophageal cancer • Stomach cancer • Adrenal Glands Gynecologic Cancers • Cervical cancer • Ovarian cancer • Uterine cancer Urological Cancers • Prostate cancer • Kidney cancer • Bladder cancer 2 - OBESITY SURGERY 3 - CARDIOVASCULAR SURGERY
ADVANCED LAPAROSCOPIC and ROBOTIC SURGERY CENTER Just as developing technologies are making every area of life easier, they are also bringing solutions to previously untreatable conditions. The aim is to achieve the best possible medical outcomes and the highest levels of patient comfort using advanced laparoscopic and robotic surgical techniques. Recognized as the pinnacle of surgical progress, robotic surgery is successfully performed in operations over a wide range of medical fields at Liv Hospital Istanbul and Liv Hospital Ankara.
A Wide Range of Uses At the Liv Hospital Advanced Laparoscopic and Robotic Center, major operations are successfully performed not only in general surgery, but also in the fields of gynecological diseases, urology, heart surgery, and obesity surgery. With its accumulated experience, Liv Hospital is progressing rapidly to becoming a robotic surgery training center. Liv Hospital’s post-operative supportive intensive care facilities and its multidisciplinary team of accomplished physicians maintain maximum levels of patient comfort.
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A Qualified and Experienced Team of Physicians Bringing significant advantages both to the doctor and patient, robotic systems deliver outstandingly successful results when implemented by an experienced team of doctors.
What is advanced laparoscopic and robotic surgery? Popularly known as keyhole surgery, laparoscopic, VATS (video assisted thoracoscopic surgery), and robotic surgery, constitute a distinct field of surgical application. With its scope spreading throughout the world to gallbladder, pancreas, lung, liver, stomach and intestinal surgery, this developing robotic surgery technology ensures shorter recovery periods. Bleeding rates are far lower than in open surgery, while fewer and smaller incisions are required. There are also cosmetic advantages, with surgical scars healing much more rapidly. Patients are able to get back on their feet more quickly, allowing for early discharge and an earlier return to normal routine and life. The infection rate is also reduced.
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Successful in complex interventions In traditional closed surgery, an incision running the entire length of the abdomen used to be necessary, in order to access the stomach. With laparoscopic (keyhole) techniques, the operation can be completed with a few incisions just 0.5–1 centimeter in length. Thanks to features such as 3-D imaging, even complex procedures can be performed using minimally invasive techniques.
How safe is advanced laparoscopic and robotic surgery? Advanced laparoscopic and robotic surgery is at least as safe as open surgery when carried out by experienced specialists. Highly successful outcomes are achieved through the efforts of the qualified and experienced team at Liv Hospital.
ADVANTAGES OF ROBOTIC SURGERY
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• Less Pain • Reduced Risk of Infection: with contact between the air in the operating theater and the abdominal cavity, the risk of infection is significantly lower than open surgery. • Safer Surgery: 3-D and magnified images achieve improved vision, protecting blood vessels and nerves. For example, blood loss during surgery is greatly reduced. • Smaller Surgical Wounds • Rapid Recovery • Shorter Hospitalization Periods • Quicker Return to Normal Life and Work
AREAS OF APPLICATION CANCER SURGERY Designed to ensure high levels of cancer control and recovery, minimally invasive surgical procedures (laparoscopic and robotic surgery) offer the highest possible degree of comfort and good health in patients’ daily lives. These techniques facilitate the complete surgical removal of organs or cancerous tissue as well as lymph nodes. A principle reason that cancer patients especially are benefitting from this kind of surgery is the more rapid recovery times that are achieved in cases when supplementary treatment (chemotherapy, medical treatment or radiotherapy) is required after surgery.
GENERAL SURGERY CANCER CASES Colorectal Cancers Cases of cancer of the large intestine and rectum treated with conventional open surgery have often been associated with large incisions, long recovery times, pain and complications. As well as advantages such as smaller incisions and rapid recovery times, minimally invasive surgery’s 3-D imaging offers greatly enhanced anatomical vision. Other advantages over open surgery include earlier return to intestine function and earlier return to oral nutrition.
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Liver Cancer
Pancreatic Cancer
Early diagnosis is crucial in cases of cancer of the liver, gallbladder and bile duct. Surgery is performed using laparoscopic and robotic techniques that minimize pain and recovery periods, granting patients various advantages including shorter periods of hospitalization and better cosmetic outcomes.
Known as an aggressive form of cancer, early diagnosis of pancreatic cancer cases is of vital importance. While surgery remains the most effective form of treatment for pancreatic cancers, chemotherapy and radiotherapy applied in a multidisciplinary context maximize success rates. Surgical treatment can be performed laparoscopically and robotically to give patients various advantages including reduced pain and shorter hospitalization and recovery periods, as well as more satisfactory cosmetic outcomes.
Esophageal Cancer Esophageal cancer (generally adenocarcinoma or squamous cell carcinoma), which manifests itself with the patient experiencing difficulty in swallowing, is mostly diagnosed by means of an endoscopic examination. Surgery is the most effective method of treating esophageal cancer. The complete removal of the esophagus is carried out using open surgery or minimally invasive surgery (laparoscopic / robotic) that offers patients various advantages including reduced pain and shorter hospitalization and recovery periods, as well as more satisfactory cosmetic outcomes.
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Stomach Cancer
Adrenal Gland Cancer
Stomach cancer surgery involves the widespread removal of the lymph nodes while carefully protecting the vascular structures. Blood supply to the stomach, the hub organ for the nutrition and digestive systems, is achieved via 3 main vessels that originate in a root vessel called the celiac trunk artery. High quality surgery serves to significantly increase disease-free survival periods. Advanced robotic methods are employed to perform expanded lymphadenectomy procedures. For this reason, stomach cancer surgery requires highly experienced and accomplished surgeons. These operations can be safely performed using laparoscopic techniques and robot-assisted surgery.
The removal of the kidney, surrounding fatty layers, and the adrenal glands, are all possible objectives depending on the size of the cancer and the extent to which it has spread. Surgery is the standard treatment for both benign and fast-growing malignant tumors. The particular surgical approach is determined according to the location and size of the tumor, and whether or not it has spread to the neighboring lymph nodes or distant organs.
GYNECOLOGIC CANCERS Minimally invasive surgery has a particular application in cases of gynecologic oncology, including advanced stage cases. Effective areas of application include cervical cancer, uterine cancer, and early stage ovarian cancers‌And procedures conducted using robotic surgery techniques also have a positive psychological impact on women undergoing cancer treatment and surgery.
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Cervical Cancer
Uterine Cancer
Laparoscopic or robotic surgery, or open surgery via the vagina or abdomen, can be carried out on young women who wish to have a baby in cases when the tumor is less than 4 centimeters in diameter and has not spread. Robotic techniques help to protect intra-abdominal nerves and prevent early stage urinary complaints.
Surgery for intrauterine membrane (endometrial) cancer yields better outcomes when carried out using robotic techniques. Overweight women are more prone to suffer from this kind of cancer; in such cases, a large surgical incision can present issues such as difficult healing, opening and infection. These complications can require weeks of treatment, which, when combined with the possible need for additional post-op radiotherapy, increases fatality rates. Robotic surgery eliminates this issue. With high quality 3-D images, surgeons are able to see and move within the affected area with ease and precision. Robotic surgery ensures even less pain than laparoscopic techniques alone.
Ovarian Cancer The gold standard in ovarian cancer treatment is the single operation performed by highly trained and experienced gynecologic oncologists without leaving any visible signs of the tumor behind. In the event that the tumor is at an early stage, small, and restricted to the ovary, removal of the womb, ovaries, abdominal fatty tissue and lymph nodes may be carried out using laparoscopic or robotic surgery.
UROLOGIC CANCERS Prostate Cancer The treatment for prostate cancer, which increases in frequency in men over the age of 50, is carried out according to the stage the disease has reached. The surgical treatment in localized cases is called Radical Prostatectomy; this can be performed using open surgery, laparoscopically or robotically. Robotic surgery offers clear advantages over open surgery in cases of radical prostatectomy. Patients may suffer post-operative urinary incontinence or erectile dysfunction depending on the age of the patient, the existence of any supplementary or additional health issues, and the precise location of the prostate cancer. • The incidence of urinary incontinence after robotic surgery is close to zero. • The risk of damaging the nerves governing erectile function is reduced by the fact that they are more clearly visible. This enables a more rapid return to sexual activity. • The robot is remarkably accurate. It enables clearer visibility and imaging, facilitating easier separation of the cancerous prostate without damaging surrounding tissue. • It has been shown that the incidence of bleeding, wound site infection and other complications is reduced using robotic techniques.
Kidney Cancer The primary treatment for kidney cancer is surgery, aiming at the complete or partial removal of the kidney. Modern techniques only remove the cancerous tissue in the case of small kidney tumors, keeping healthy kidney tissue intact. The introduction of robotic surgery over the past 10 years enables patients to gain all the benefits of minimally invasive surgery while maintaining the technical ease of open surgery. • Robotic partial nephrectomy surgery accesses the affected region via 8-10 millimeter abdominal incisions, rather than the large incisions required by conventional (open) surgery. • Compared to open surgery, hospitalization periods are greatly reduced. • Blood loss is minimized. • The removal of the tumor and repair of the remaining kidney tissue is performed efficiently and precisely, with exceptionally fine imaging quality.
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Bladder Cancer Bladder cancer, in which smoking remains the most significant risk factor, is treated according to the stage that it has reached. In the event that the cancer has spread deep into the muscle of the bladder, the complete removal of the bladder may be necessary. • While open surgery requires a surgical incision running 10 – 15 centimeters as far as the base of the penis, robotic techniques access the affected area via 5 or 6 small holes through which thin pipes and the robotic device are inserted. • Rapid post-op metabolic recovery is facilitated by the fact that the patient does not suffer loss of temperature, fluid or electrolytes. • Recovery is quickened by the fact that the patient experiences much less blood loss. • If the state of the bladder cancer allows, the nerves governing sexual function are protected, allowing an earlier return to normal sexual activity.
Ensuring safer surgery Robotic surgery is superior to thoracoscopic surgery in a number of ways; by achieving 3D rather than 2D imaging, it ensures sharper and clearer images, high depth perception, and therefore greater surgical adaptability. In addition, the tools and devices used in robotic surgery are highly superior in terms of maneuverability. All these advantages ensure higher levels of surgical safety.
OBESITY SURGERY Turkey is amongst the top European countries in terms of obesity rates, with the condition affecting some 40% of women and 20% of men. With high success rates, obesity and metabolic surgery has gained prominence and is used more frequently to treat diseases associated with obesity, such as diabetes and high blood pressure.
Enhancing the surgeon’s perception of dept Gastric bypass surgery is regarded as the gold standard in this kind of surgery. As well as providing clearer images, the robotic surgery system provides the surgeon with depth of vision and the sense of depth of movement by providing a 3D image of the field of operation. Since the camera is under the surgeon’s control and can give ten times magnification, it also allows the surgeon to operate easily in confined and narrow spaces that are inaccessible using regular keyhole techniques. This serves to minimize the extent of surgical injury.
Reduced leakage Robotic surgery is conducted with very small surgical incisions, with far better esthetic results. Furthermore, side effects that can extend the patient’s period of hospitalization such as bleeding or leakage are reduced. The most significant issue facing obesity surgery patients is leakage. Compared to laparoscopic surgery, robotic techniques greatly reduce the leakage rate.
Experience is key Even when conducted laparoscopically, obesity surgery is challenging to learn and to master; the development of side effects can threaten the life of the patient. Robotic techniques used for difficult operations such as gastric bypass surgery offer the patient very significant advantages.
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CARDIOVASCULAR SURGERY
Advances in heart surgery especially over the past 15 years have served to increase the field of application for minimally invasive techniques as an alternative to conventional methods. In particular, bypass operations conducted in recent years have given patients significant benefits in terms of comfort and the speed of recovery. The robotic bypass procedure is carried out via three small incisions in the armpit area and a 4 centimeter incision in the rib area, without the need for scalpels or arresting the heart. The camera that is inserted via one of the incisions renders clear 3-D images with 8 to 10 times magnification. One surgeon operates the robotic arms using surgical instruments, while the other operates the instruments located in the console where the camera is located. In appropriate cases, robotic surgical techniques can be employed in cases of coronary artery by-pass surgery, mitral valve surgery, congenital heart surgery and arrhythmia surgery. Coronary artery by-pass surgery can be carried out without the need to arrest the heart (using a heart-lung machine). Mitral valve surgery is performed after arresting the heart. Rapid return to normal life Unlike conventional bypass surgery, the chest area is not opened and the operation proceeds without the need to arrest the heart. The patient can return to normal life far more rapidly after robotic bypass surgery. Infection rates and bleeding are greatly reduced, and cosmetic outcomes are superior due to far smaller surgical incisions. Patients are able to regain their normal physical condition more quickly.
Less pain, lower infection rates Robotic techniques are used in appropriate cases during coronary bypass, mitral valve, congenital heart and arrhythmia surgery. Coronary bypass surgery is carried out without arresting the heart, or using a heart-lung machine after stopping the heart. Mitral valve surgery is performed after arresting the heart. Patients who have undergone robotic heart surgery experience significantly shorter convalescence periods, and are generally able to return to work after 15 days. Bleeding, infection, pain and blood use are greatly reduced.
Greater ease for both patient and surgeon The devices and tools used in robotic surgery are operated differently from those in traditional or thoracoscopic surgery, offering higher levels of safety. Finger-operated by the surgeon from a console, the surgical devices can easily achieve precise movements that are difficult even for the human wrist to perform. Hand shaking and fatigue are eradicated, and anatomical areas that are difficult to reach are more easily accessed. This provides both patient and surgeon with a greater level of ease and comfort.
The address where experience meets robotic surgery
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LiV HOSPITAL ULUS AND ANKARA ADVANCED LAPAROSCOPIC AND ROBOTIC TRAINING As well as implementing advanced surgical techniques in fields such as general surgery, gynecology, urology and orthopedics, our team of experienced and specialized physicians also strive to transfer their experience to their colleagues in Turkey and internationally. Thanks to the flow of general surgeons, especially those from abroad and from neighboring countries who come to learn minimally invasive surgical applications, Turkey has gained increased global prominence as a center of experience and accomplishment in the field.
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