Cagdas Sahin

Contained Morcellation: Review of Current Methods and Future Directions

Power morcellation of surgical specimen during laparoscopic surgery is a practical technology that provides the opportunity to perform several minimally invasive procedures. However, this technology brought forward additional risks and complications associated with dissemination of both benign and malignant tissues inside the abdominal cavity. Based on startling cases, Food and Drug Administration (FDA) announced a discouraging statement on the use of power morcellators that decreased the number of minimally invasive approaches in the following period. As a response to these concerns and negative impacts of the FDA statement, researchers developed several new approaches resulting in contained or in-bag morcellation methods. In this review, we aimed to discuss these current methods and provide an insight for future developments.

Sexual dysfunction in infertile Turkish females: prevalence and risk factors

OBJECTIVES Our aim was to evaluate the prevalence of and risk factors for sexual dysfunction in infertile Turkish females. STUDY DESIGN We interviewed 352 infertile and 301 fertile females in the Department of Obstetrics and Gynaecology at Tepecik Training and Research Hospital in Izmir, Turkey. The female sexual function index (FSFI) was used to assess the relationship between infertility and female sexual function. RESULTS The mean age was similar between the infertile and control groups (29.2±4.3 vs. 28.7±4.0, respectively; p=0.120). The prevalence of sexual dysfunction in infertile females was higher than that in the fertile control group (32.9 vs. 17.2%, p<0.001), and the total FSFI score (26.2±2.5 vs. 28.2±1.7) and the score on each domain of sexual function parameters were significantly lower in the infertile group than in the control group (all p<0.001). Multivariate logistic regression analysis indicated that a duration of marriage and of infertility ≥3 years (odds ratio [OR] 3.79, 95% confidence interval [CI] 1.75-8.20, p=0.001; OR 3.18, 95% CI 1.54-6.55, p=0.002, respectively) and a history of previous infertility treatment (OR 3.07, 95% CI 1.63-5.76, p<0.001) were risk factors for sexual dysfunction in infertile females. CONCLUSIONS Female sexual dysfunction was higher in the infertile group than the fertile control group in this Turkish population. Duration of marriage and of infertility ≥3 years and a history of previous infertility treatment were the primary risk factors for sexual dysfunction in infertile females.

Should we remove the normal-looking appendix during operations for borderline mucinous ovarian neoplasms?: A retrospective study of 129 cases

INTRODUCTION The aim of this study was to determine how often the appendix is involved or the primary source of cancer in women undergoing surgery for mucinous borderline ovarian tumour (mBOT) or invasive mucinous ovarian tumour (IMOT) and to evaluate whether appendectomy is necessary. METHODS The hospital database was searched for women who underwent surgery and whose final diagnosis was mBOT, IMOT or mucinous appendix carcinoma between 1998 and 2014. RESULTS One hundred and twenty-nine cases were identified, including 69 mBOT, 51 IMOT and nine primary mucinous appendix carcinomas. Of 97 appendectomies performed, nine lymphoid hyperplasia, two mucocele, one carcinoid tumour of the appendix, one mucinous tumour metastasis from the ovary and nine primary mucinous appendix carcinomas were found and all appendices were grossly abnormal. No recurrence was seen during the follow-up period in 28 patients who had no appendectomy performed for grossly normal appendix. Pathologic diagnosis was normal in all 65 patients whose appendix was noted to be grossly normal and who underwent appendectomy. No recurrence was detected during a median follow-up period of 7 years (range 1-16 years).Sensitivity, specificity, positive and negative predictive value of the macroscopic appearance of the appendix were 100%, 86.67%, 56.52% and 100.00%, respectively. DISCUSSION If the appendix is grossly normal, it appears unnecessary to perform an appendectomy in patients operated for an adnexal mass and whose frozen section analysis was reported as mBOT or IMOT. CONCLUSION Appendectomy should not be performed if the appendix is grossly normal.

The impact of salpingectomy and single-dose systemic methotrexate treatments on ovarian reserve in ectopic pregnancy.

OBJECTIVE To investigate the effects of salpingectomy and methotrexate treatments on ovarian reserve in ectopic pregnancy. STUDY DESIGN In this prospective study, a total of 131 patients with ectopic pregnancy were divided into 3 groups of methotrexate (MTX) only (Group-1, n: 55), salpingectomy only (Group-2, n: 61), and salpingectomy following MTX (Group-3, n: 15). Pretreatment and post-treatment anti-Müllerian hormone (AMH) levels were evaluated. RESULTS Significant differences in AMH levels were detected between group 1 and group 2 (2.52±1.28 vs. 1.96±1.66, p=0.043), and group 1 and group 3 (2.52±1.28 vs. 1.77±0.76, p=0.035) at one month postoperative. However, these differences disappeared at the 3rd postoperative month. When AMH levels were compared within the same group, postoperative one month AMH levels were significantly lower than the preoperative AMH levels only in group 3 (p=0.03). However, this difference also disappeared at the 3rd postoperative month. CONCLUSION Systemic single-dose methotrexate treatment, unilateral salpingectomy, and salpingectomy following methotrexate administration in ectopic pregnancy were reassuring based on pretreatment and post-treatment AMH levels. Current medical and surgical treatment approaches do not have an obvious negative effect on ovarian reserve.

Comparison of three-dimensional ultrasound and magnetic resonance imaging diagnosis in surgically proven Mullerian duct anomaly cases

OBJECTIVE To determine and compare the diagnostic accuracy of 3-dimensional ultrasound (3D US) and magnetic resonance imagining (MRI) in patients with surgically diagnosed Mullerian duct anomaly (MDA). STUDY DESIGN Charts of patients with MDA were retrospectively evaluated. Patients who underwent both laparoscopic and hysteroscopic surgery and had 3D US and MRI examinations were included in the study. The diagnoses achieved via 3D US and MRI were compared with the surgical diagnoses to determine the diagnostic accuracy of these imagining techniques. RESULTS Twenty-nine patients were included in the study. Three-dimensional ultrasound detected 28 out of 29 (96%) patients correctly. Only one patient was diagnosed with a uterine septum instead of uterine arcuatus. Magnetic resonance imaging detected 23 out of 29 patients correctly (79%). The Kappa indexes of the 3D US and MRI were 0.896 and 0.592, respectively. CONCLUSION Our results indicate that 3D US has a higher diagnostic accuracy level than MRI in evaluating MDA, especially when used in experienced hands. However, additional, well-designed studies are needed to better compare the diagnostic accuracy of the 3D US and MRI.

Can striae be used as a marker for the prediction of pelvic organ prolapse

OBJECTIVE To investigate the relationship between two connective tissue pathologies: striae and pelvic organ prolapse (POP). STUDY DESIGN Four hundred and eighty-eight women who had undergone gynaecological surgery were divided into two groups. The study group (n=244) consisted of symptomatic patients with POP, and the control group (n=244) consisted of cases who underwent surgery for benign gynaecological conditions without evidence of POP. The groups were compared in terms of the presence, intensity and severity of striae, as well as their general characteristics. RESULTS The presence of striae (p=0.001), number of striae (p=0.001) and Davey score (p=0.00001) were significantly higher in the study group, and the absence of striae was more common in the control group (p=0.00001). According to multivariate analysis, the presence of striae, an increased number of striae (>15) and a Davey score >2 increased the risk of POP 1.29 fold (p=0.03, 95% confidence interval [CI] 1.14-1.35), 1.19 fold (p=0.04, 95% CI 1.14-1.25) and 2.51 fold (p=0.01, 95% CI 1.66-3.78), respectively. CONCLUSION Striae may serve as a promising marker for POP. In particular, women who develop striae should be cautious about their risk for developing POP in the future, and should be informed about preventive methods for POP.

Does high maternal first trimester iron status have an effect on the 50 g oral glucose test

Abstract We aimed to test the hypothesis that 1st trimester high body iron status is associated with a high positive 50 g oral glucose tolerance test. In this study, 29 pregnant women with positive 50 g oral glucose tolerance test were compared with 94 negative 50 g OGTT patients as the control group in terms of 1st trimester iron status. Both groups had similar age, weight, height, body mass index and also median gravidity and parity values. Our results showed that there were no differences between groups in mean haemoglobin, haematocrit, serum iron, serum ferritin, total iron binding capacity and transferrin. Since it seems that free radicals have much influence on oxidative stress and glucose metabolism, prospective, randomised clinical trials should be designed to demonstrate the possible relation between maternal iron status and glucose intolerance.

Paratubal Borderline Tumor Diagnosed In The Adolescent Period: A Case Report And Review of The Literature

BACKGROUND Borderline paratubal cysts are rare entities. These tumors are identified as epithelial proliferation without stromal invasion. CASE A 19-year-old virgin patient was admitted to our clinic with abdominal pain and nausea. The sonographic evaluation showed a left adnexal mass 89 × 80 mm in diameter with solid tissue projections. Doppler examination revealed no significant blood supply. At surgery, a torsed left paratubal cyst 10 cm in diameter and normal bilateral ovaries were encountered. Cystectomy was performed and of frozen section revealed a borderline Fallopian tube neoplasm. Final pathology review was reported as a serous borderline paratubal tumor. CONCLUSION The evaluation of the structure of cyst by ultrasound and the performance of intraoperative frozen section analysis are two important issues to diagnose the nature of a cyst. Fertility-sparing surgery is the main point of management.

Which Should Be the Preferred Technique During Laparoscopic Ovarian Cystectomy Hemostatic Sutures or Bipolar Electrocoagulation? A Randomized Controlled Prospective Study of Long-Term Ovarian Reserve

The aim of the present study was to determine the long-term effects of different laparoscopic hemostatic techniques on ovarian reserve after ovarian cystectomy. Ninety patients with unilateral ovarian cysts were recruited and randomly distributed into 2 groups. Laparoscopic stripping cystectomy was performed in all patients. Afterward, cystectomy hemostasis was achieved via hemostatic suture or bipolar electrocoagulation. Serum levels of anti-Müllerian hormone (AMH) were determined preoperatively and postoperatively at 1, 3, and 12 months, and patients were evaluated for residual ovarian volume, antral follicle count, and pregnancy. The statistical difference was determined between the 2 groups in terms of AMH levels at 3 months (hemostatic suture group = 3.17 ± 3.40 vs bipolar electrocoagulation group = 2.38 ± 2.57, P = .006) and 12 months (hemostatic suture group = 3.71 ± 3.09 vs bipolar electrocoagulation group = 2.78 ± 2.85, P = .005). In addition, in the hemostatic suture group, there was no statistically significant difference between preoperative and postoperative AMH levels (P = .165) and between the postoperative antral follicle count (P = .779) and the residual ovarian volume (P = .248), whereas in the bipolar electrocoagulation group, postoperative AMH levels were lower than preoperative levels (P = .028) and postoperative residual ovarian volumes at 3 and 12 months were lower than those at 1 month (P = .001). Nonetheless, pregnancy rates were not significantly different (P = .546). Bipolar electrocoagulation is more destructive compared with hemostatic suture. However, the ovarian reserve does not decrease further during the follow-up period.

Cesarean myomectomy for solitary uterine fibroids: Is it a safe procedure?

Objectives: Myomectomy during cesarean is still controversial. Our aim is to assess the safety and feasibility of myomectomy during cesarean section for solitary uterine fibroids in terms of intraoperative and postoperative risks. Material and methods Data from 306 patients with leiomyoma undergoing elective cesarean operations were reviewed retrospectively. Eighty-two patients who underwent myomectomy during cesarean section were compared to 224 patients diagnosed with myoma who did not undergo myomectomy. The patients were reviewed for preand post-operative hemoglobin values, duration of operation, amount of intraoperative hemorrhage, need for blood transfusion, and duration of hospital stay. Results: The decrease in hemoglobin values after operation was not significantly different between the groups (1.48±0.7 vs. 1.31±0.68 g/dL; p = 0.063). Both the hospital stay and operation durations were significantly longer in the myomectomy group (57.9±19.7 vs. 50.54±20.77 hours, p = 0.006; 39.94±12.5 vs. 35.27±9.1 minutes, p=0.001, respectively). The operation duration was significantly shorter in the group with myomas = 3 cm in size (35.41±9.33 vs. 45.58±16.57 vs. 47.05±10.61 minutes; p < 0.05). Conclusions: Cesarean myomectomy did not increase intrapartum or early postpartum morbidity. Thus, we suggest that myomectomy can be performed during cesarean section in selected patients to avoid repeat operations and additional cost.