Ahmet Göçmen

Effects of maternal obesity on antenatal, perinatal and neonatal outcomes

Abstract Objective: Obesity is critically important to maternal and fetal health during the perinatal period. We have detected an increasing prevalence of maternal obesity in recent years and investigated its complications during pregnancy. Methods: A total of 931 pregnant females were investigated between March 2012 and March 2013. The patients were divided into four groups: body mass index (BMI) < 18.5 kg/m2 was underweight, 18.5–24.9 kg/m2 was normal weight, 25–29.9 kg/m2 was overweight and ≥30 kg/m2 was obese. The effects of obesity on fetal and maternal outcomes were investigated. Results: Significant increases in pregnancy-induced hypertension, gestational diabetes mellitus, cesarean delivery, premature rupture of membranes, shoulder dystocia, meconium-stained amniotic fluid, abnormal heart rate pattern and postpartum infection rates were found in the obese group during the perinatal period. Adverse maternal effects in obese cases were significantly more frequent than those in normal-weight cases. Preterm birth, perinatal mortality, low APGAR scores, newborn intensive care unit requirement, hypoglycemia and macrosomia rates were significantly higher in obese cases than those in non-obese cases. However, low birth weight infant rate was higher in the low BMI cases than that in the other BMI categories (p < 0.01). Conclusion: We conclude that obesity is an important factor associated with pregnancy complications and the increase in maternal-fetal morbidity and mortality.

Conservative laparoscopic approach to adnexal torsion

ObjectiveTo evaluate the conservative laparoscopic approach to adnexal torsion during reproductive age.MethodsWe present 18 patients with adnexal torsion between January 1997 and December 2005. Patients treated conservatively were controlled by ultrasonography during the postoperative period.ResultsOf 18 patients with adnexal torsion, 12 patients were treated by conservative laparoscopic surgery after detorsion, one patient with only tubal torsion had undergone laparoscopic salpengectomy. Laparoscopy was converted to laparotomy after laparoscopic detorsion in five cases. Of five patients in this group, four patients was performed cystectomy, one patient salpingo-oopherectomy. Conservative treatment was carried out in 16 of 18 cases with adnexal torsions.ConclusionConservative management is a safe way to preserve the ovarian function during the reproductive period.

Robot‐assisted hysterectomy vs total laparoscopic hysterectomy: a comparison of short‐term surgical outcomes

The objective of the study was to compare the short‐term outcomes of robot‐assisted hysterectomy with laparoscopic hysterectomy.

Robotic-assisted infrarenal aortic lymphadenectomy and pelvic lymphadenectomy for endometrial staging using a single docking procedure.

► We describe a new technique for robotic infrarenal para-aortic lymphadenectomy. ► This technique includes the new robotic trocar insertion sites. ► We perform the complete lymphadenectomy with a single docking procedure. ► This technique is feasible for complete lymphadenectomy in endometrial staging.

Two Live Births following Robotic-Assisted Abdominal Cerclage in Nonpregnant Women

Introduction. To report the robotic-assisted abdominal cerclage performed in two nonpregnant women and the success of live birth outcomes. Presentation of Cases. A 36-year-old woman with a complaint of recurrent second trimester pregnancy losses and a 35-year-old patient with a complaint of preterm deliveries and cervical insufficiency underwent robotic assisted abdominal cervicoisthmic cerclage placement in nonpregnant period. The two patients had spontaneous pregnancy after the robotic-assisted abdominal cerclage and delivered healthy infants. Discussion. The limitations of traditional laparoscopic abdominal cerclage have been accomplished with robotic surgery advantages especially intuitive movements and increased range of motion. There are only a few studies in the literature including robotic assisted abdominal cerclage in nonpregnant women, and only five successful live birth outcomes were reported. In this paper, we reported the sixth and seventh cases of achieved live pregnancy after robotic assisted abdominal cerclage in the literature. Conclusion. Robotic assisted abdominal cerclage is a good alternative surgical method with successful pregnancy outcomes.

A Rare Reason for Pelvic Pain in Pregnancy: Infectious Sacroiliitis.

Introduction. Although the incidence of pregnancy-associated sacroiliitis is low, it is associated with significant morbidity and mortality. Timely diagnosis of the disease is confusing due to its nonspecific clinical features. Case. A 28-year-old woman at 34 weeks of gestation with severe pain in her right buttock radiating down the backside of the right thigh was admitted to our hospital. White blood cell (WBC) count and C-reactive protein (CRP) were elevated. The pelvic magnetic resonance imaging (MRI) scan revealed right sacroiliitis. Conclusion. Infectious sacroiliitis should be considered as a differential diagnosis even in low-risk women who present with debilitating pelvic pain in pregnancy and medical treatment should not be delayed.

Four Cases of Chylous Ascites following Robotic Gynecologic Oncological Surgery

Chylous ascites is an uncommon form of ascites characterized by milky-appearing fluid caused by blocked or disrupted lymph flow through chyle-transporting vessels. The most common causes of chylous ascites are therapeutic interventions and trauma. In this report, we present four cases of chylous ascites following robot-assisted surgery for endometrial staging and the treatment strategies that we used. After retroperitoneal lymph node dissection, leaving a drain is very useful in diagnosing chylous ascites and observing its resolution; furthermore, the use of octreotide in conjunction with TPN appears to be an efficient treatment modality for chylous ascites and should be considered before any invasive intervention.

Robot-assisted tubal reanastomosis: Initial experience in a single institution

OBJECTIVE To assess surgical outcomes for robot-assisted tubal reanastomosis in a single institution. MATERIALS AND METHODS Between March 2009 and January 2010, 10 patients underwent robot-assisted tubal ligation reversal (TLR) with a da Vinci S surgical system. Patient demographic data, including operative times, operative and postoperative complications, hospital stay, conversion to laparotomy and pregnancy rates were recorded. RESULTS Mean age and body mass index for the patients were 37.7 (35-42) years and 28.9 (23.9-36.3) kg/m(2), respectively. The mean console time was 102.5 min and the mean total operation time was 130.6 (102-164) min. The mean hospital stay was 1.2 (1-2) days. There were no significant intra-operative or early-postoperative complications. All surgeries were completed robotically with no conversion to laparotomy. There were seven subsequent pregnancies in the study participants, representing a pregnancy rate of 70%, of which five were intrauterine pregnancies, one was an ectopic pregnancy, and one was an abortus. CONCLUSION Robot-assisted TLR is safe and feasible. This procedure may facilitate minimally invasive treatment for patients who want to regain their fertility without the aid of artificial reproductive techniques.

Female adnexal tumor of probable Wolffian origin diagnosed during the staging evaluation of extranodal diffuse large B-cell lymphoma

Female adnexal tumor of probable Wolffian origin (FATPWO) is a rare neoplasm arising within the leaves of broad ligament or hanging from it or a fallopian tube. A 55-year-old female patient with the diagnosis of non-Hodgkin lymphoma is presented. The staging procedure revealed a pelvic mass that was not regressed by chemotherapy. Explorative laparotomy showed FATPWO. The extremely rare coexistence of FATPWO in the staging evaluation of non-Hodgkin lymphoma is reported. According to our knowledge, this is the first case of FATPWO coexisting with extranodal diffuse large B-cell lymphoma in the English-language literature.

Is Cryotherapy Friend or Foe for Symptomatic Cervical Ectopy

Objective: To evaluate the success rates and clinical outcomes of cervical cryotherapy applied to cervical ectopy for symptomatic relief. Subjects and Methods: A total of 124 women who underwent cryotherapy for symptomatic treatment of cervical ectopy were included in this study. Indications for treatment were: abundant leucorrhoea (n = 114), post-coital bleeding (n = 22), recurrent cervicitis (n = 30) and pelvic pain (n = 12). Cryotherapy consisted of the use of carbon dioxide at -89°C to destroy the ectopic columnar epithelium by freezing, and it was transmitted to the ectopy through a flat cryoprobe. No routine anaesthesia or analgesia was administered. All patients were questioned about the status of their symptoms after 6 weeks of treatment. Results: The highest success rate was obtained in patients with abundant leucorrhoea (n = 102; 89.5%), while the lowest success rate was achieved in subjects with pelvic pain (n = 7; 58%). After treatment, no severe complications were observed, except for hydrorrhoea for a few days. Success rates were 9 times lower in patients who had 3 or more cervicitis episodes per 6 months. Conclusion: In this study, the success rate of cryotherapy was highest in patients with abundant leucorrhoea and lowest in patients with pelvic pain and recurrent cervicitis. Hence, we recommend that clinicians perform the procedure in such patients without much delay.