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KARS is a novel, single incision, gasless laparoscopic surgery technique. Various operations* may be performed through the
intra-umbilical transverse incision without using CO2 pneumoperitoneum and thus the trocars (keyless).
Principles of KARS:
A. Abdominal access pathway
1. 1.5- 2cm transverse intra-umbilical incision
2. The facial layer underlying the incision is sutured and elevated at 6 and 12 o�clock positions
B. Rope-lifting process
1. The needle of the Veress cannula is removed, and one tip of a no. 1 nylon suture is inserted approximately 8�10 cm into the
2. The loaded cannula is introduced into the elevated entry, 1�2 cm below the entry it�s slid just above the peritoneum and
oriented laterally right or left 6�7cm. The abdominal wall is pierced from the inside toward the outside, and the suture is unloaded
from the cannula outside the abdominal wall. After removal of the unloaded cannula back from the entry by loading of the
second suture tip into the cannula, the same procedure is repeated; however the second exit is 5-6 cm below the first.
3. The same procedure is repeated at the contra-lateral side.
4. The abdominal wall is elevated by an assistant, and the sutures are tied over the pre-prepared sterile retractor.
5. The telescope and the hand instruments are introduced without using trocars and the specific operations are performed
through the single incision.
*We performed more than 70 operations including the diagnostic laparoscopy, ovarian cyst excision, oophorectomy, tubal
ligation, salpingectomy, salpingostomy, salpingo-oophorectomy and hysterectomy.
Kahraman ?lker had MD degree from Istanbul University Cerrahpasa School of Medicine in 1994. He received MD degree in Obstetrics and Gynecology in 2000 and in 2009 he began to work in Kafkas University School of Medicine, Kars with a degree of assistant professor. He has published 30 papers and 51 presentations in different aspects of Obstetrics and Gynecology. He serves as a reviewer and editorial board member in Kafkas Journal of Medical Sciences, Asian Pacific Journal of Reproduction and World Journal of Minimal Access Surgery. He is the associate editor of Kafkas Journal of Medical Sciences.
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