Ghanim Khatib

Mature cystic teratoma of the fallopian tube

Teratoma of the fallopian tube (cystic or solid) is a rarely encountered tumour and, to date, only 73 cases have been reported in the literature. A comprehensive review has not been done since 1972, when Mazzarella and colleagues reviewed 44 cases of tubal teratomas. This situation has prompted us to survey the literature to update the data on tubal teratoma cases. The majority of the tumours were benign. The tumour was cystic in nature in 50 cases. Patients’ ages ranged between 17 and 67 years. None of them was diagnosed preoperatively. Half of the tumours were ≤ 5 cm, whereas the other half were > 5 cm in diameter. About two-thirds of the patients were associated with two or fewer gravidity. To the best of our knowledge, the present case included in our paper is the first tubal cystic teratoma reported from Turkey.

A novel technique: Carbon dioxide gas-assisted total peritonectomy, diaphragm and intestinal meso stripping in open surgery for advanced ovarian cancer (Çukurova technique)

OBJECTIVE Most of the ovarian cancers are diagnosed at advanced stages. As peritoneal carcinomatosis increases, especially when it extends to the diaphragm and intestinal mesos, probability of obtaining complete cytoreduction is reduced. Complete cytoreduction (residue zero: R0) is one of the main factors affecting survival [1-3]. Here we present a novel technique of stripping the peritoneal surfaces as a part of cytoreductive surgery in such cases. METHODS A 55year-old woman diagnosed with peritoneal carcinomatosis was considered appropriate for primary cytoreduction after assessment of her thorax-abdominopelvic tomography, which revealed resectable intra-abdominal disease. Upon laparotomy, omental cake adherent to pelvis-filling mass, disseminated implants on the diaphragm, meso of the descending colon and small intestine were observed. The mass invaded the rectosigmoid colon, uterus, adnexa and the bladder resulting in frozen pelvis. Palpable retroperitoneal pelvic and para-aortic lymph nodes were detected. On the other side, stomach, anti-mesenteric surfaces and mesentery root of the small bowel were tumor-free. Hence, upon these perioperative and preoperative imaging findings, complete cytoreduction was thought to be achievable. Therefore, primary cytoreduction was performed. Total omentectomy, hysterectomy with bilateral salpingo-oophorectomy, rectosigmoid low anterior resection and retroperitoneal lymphadenectomy were performed. With the assistance of an injector needle connected to the insufflator tube (as in laparoscopic surgery), carbon dioxide gas was blown into the right retroperitoneal area and subsequently peritoneum was rapidly stripped up to the right diaphragm. The same procedure was then applied to the diaphragm and meso of the bowels, respectively. Owing to this technique, total stripping of all involved peritoneal surfaces was clearly facilitated and R0 goal was reached. RESULTS Gas insufflation caused convenient detachment of the peritoneal surfaces along their anatomical line which led to concluding the stripping procedures easily, rapidly and safely without bleeding. Thus, according to our experience, about 10 to 15min per procedure are saved in such cases. Potential complications of CO2 gas used here are not superior to those in transperitoneal or retroperitoneal laparoscopic procedures. During the operation, patient was followed-up for potential complications such as subcutaneous emphysema and CO2 gas embolism.Thus, hourly blood gas was monitored. Another potential complication is injury of the vessels while inserting the needle which can be avoided by cautious inserting under the peritoneal surfaces superficially and using transillumination. In case such injuries happen, tamponing is a sufficient measure. In our serial, no perioperative complications belonging to this technique were encountered. However, long term outcomes such as precise time difference, difference in blood loss, complication rates, adhesions, morbidity associated with this technique and its impact on survival of the patients with advanced ovarian cancer have yet to be investigated. Therefore, a prospective study to validate this techniques long-term usefulness has been initiated in our clinic. CONCLUSION We believe that this practical and effective technique will offer significant improvements in efforts to achieve complete cytoreduction.

Does preoperative neutrophil to lymphocyte or platelet to lymphocyte ratios have a role in predicting borderline ovarian tumors

Backgroundto investigate the value of using preoperative neutrophil to lymphocyte and platelet to lymphocyte levels in the patients of borderline ovarian tumors.MethodsDuring the period between January 2002 and December 2015, the pathology reports and archival files of the Gynecologic Oncology Department of Çukurova University Medical Hospital and the Gynecologic Oncology Department of Dumlupınar University, Evliya Çelebi Education and Research Hospital were retrospectively reviewed, and 144 patients of borderline ovarian tumor (as the study group) and 123 patients of serous cystadenoma (as the control group) were determined for eligibility in this study. Data regarding age, menopausal status, preoperative ultrasound findings, ca125 and complete blood counts were reviewed. Neutrophil to lymphocyte and platelet to lymphocyte ratios were calculated and these parameters were statistically compared between the groups.ResultsThere was a statistically significant difference between the groups according to neutrophil count, platelet count, neutrophil to lymphocyte ratio and platelet to lymphocyte ratio; in addition to age, ca125 and preoperative ultrasound findings.ConclusionsIt seems that neutrophil to lymphocyte and platelet to lymphocyte ratios are useful in predicting borderline ovarian tumors, preoperatively. However, further prospective studies are needed.

Asymptomatic groin dermatophyte carriage detected during routine gynaecologic examinations

We investigated the epidemiological characteristics of both symptomatic and asymptomatic dermatophytic groin infections in 1970 women (age: 36.2 ± 12.5) during routine gynaecologic examinations. Bilateral groin samples were collected with sterile cotton swabs premoistened with sterile physiological saline. The samples were then separately inoculated onto Sabouraud glucose agar. Fungi were identified by sequencing the rDNA internal transcribed spacer region. Dermatophytes were recovered from five patients (four Trichophyton rubrum and one Arthroderma vanbreuseghemii, 0.25%) with a diagnosis of asymptomatic carriers (four) and tinea inguinalis (one). In one case, groin carriage converted into tinea inguinalis after 3 weeks. Analysis of risk factors indicated that patients of at least 49 years were more likely to be positive for dermatophyte isolation (P = 0.002). In conclusion, groin dermatophyte carriage is more common than tinea inguinalis and can potentially convert into a symptomatic infection.

Laparoendoscopic Single Site Total Hysterectomy: Single Institution Initial Experience

ABS TRACT Objective: To compare the periand post-operative outcomes between the laparoendoscopic transumblical single-site total hysterectomy (LESS-TH) and conventional three-port total laparoscopic hysterectomy (TLH). Material and Methods: A single institution retrospective review of patients operated on with LESS-TH (n= 24) and TLH (n=47) for benign uterine pathology or endometrial cancer with low-risk factors from March 2013 to March 2014. Patients underwent LESSTH surgery through a single 2-3 cm transumbilical incision with a multi-channel SILS TM port (Covidien®, Mansfield, MA, USA). Patient demographics and peri-operative and post-operative variables were analyzed and compared between the groups. Results: There was one conversion to conventional laparoscopy and one conversion to laparotomy in the LESS-TH group, and no cases converted to laparotomy in the LTH group. Demographic characteristics such as age, body mass index (BMI), and indications were similar between the groups (p=0.497, 0.07, 0.594, respectively). Operation time was significantly longer in the LESS-TH group than in the TLH group (p=0.01). The other periand post-operative variables such as uterus length and width, estimated blood loss, post-operative Hb level drop, post-operative hospitalization time and analgesic management were found to be similar between the two groups. There were no major complications in either of the groups. Conclusion: With the exception of operative time, the surgical outcomes of the LESS-TH group were comparable to those of the conventional multiport TLH group.

Annular hymenotomy for imperforate hymen

Imperforate hymen is the most common obstructive anomaly of the female genital tract. Conventional surgical treatment for this condition is the cruciate incision made on the hymen. The aim of this study was to evaluate a novel technique that preserves virginity after hymenotomy using electrocautery.

A Single-Institution Radical Surgery Results in Stage IB2/IIA2 (Bulky) Cervical Cancer.

Objective The aim of this study is to evaluate the results of radical surgery in patients with stage IB2 to IIA2 cervical cancer who were operated on at our center between 2002 and 2015. Materials and Methods Forty-seven cases of patients with stage IB2/IIA2 cervical cancer who underwent primary radical surgery between 2002 and 2015 were enrolled in this study. Patients’ files and pathological reports were retrospectively reviewed. Surgical, pathological, and clinical variables were analyzed and their impact on survival period was researched. Disease-free survival and overall survival periods were determined using the Kaplan-Meier test. The P value was considered significant if less than 0.05. Results Type C2 radical hysterectomy with lymphadenectomy (5 pelvic, 42 pelvic and para-aortic) was performed for all of the 47 patients in accordance with the Querleu-Morrow classification. Thirty-three of the cases were stage Ib2 and 14 cases were IIa2. Five years of overall survival was 80%. Recurrence was noted in 10 (7 pelvic, 3 extrapelvic) patients. Adjuvant therapies were needed for 83% of the patients. A univariate analysis was made for all included variables in this research and, other than recurrence, none of them was found to be statistically significant on OS and DFS. Conclusions Although adjuvant therapies are often resorted to, primary radical surgery is also a reasonable treatment option for stage IB2/IIA2 cervical cancer, especially in young premenopausal patients when preserving ovarian functions is desired.

Tek merkezli borderline over tümörlerinin 5 yıllık retrospektif analizi

Amac: Bu calismada, klinigimizde son 5 yilda opere edilen bordeline over tumorlu vakalarin degerlendirilmesi amaclanmistir. Gerec ve Yontem: Cukurova Universitesi Tip Fakultesi Jinekolojik Onkoloji biriminde son 5 yil icerisinde opere edilen borderline over tumorlu olgularin, patoloji raporlari ve birimin bilgisayar kayitlari ile arsiv dosyalari retrospektif bir sekilde tarandi. Toplam 41 vaka tespit edilip calismaya dahil edildi. Olgularin demografik karakteristikleri, preoperatif muayene bulgulari, operasyon ve patoloji ozellikleri degerlendirildi. Bulgular: Hastalarin ortalama yasi 41 idi ve %85’i premenopozal donemde idi. Preoperatif donemde bakilan ultrasonda, tumorun ortalama capi 10 cm olarak olculdu. Operasyon oncesi ortalama ca125 degeri 120 olarak tespit edildi. Total histerektomi + bilateral salpingooferektomi 12 hastaya uygulanirken, geri kalan 29 hastaya unilateral salpingooferektomi uygulandi. Lenfadenektomi, hastalarin %41.5’inde gerceklestirildi. En sik seroz histopatolojik tip (%70.7) izlendi. Hastalarin cogunda (%90.2) tumor, evre I’de idi. Hic bir olguda nuks tespit edilmedi. Sonuc: Borderline over tumorleri, iyi prognoza sahip oldugundan, fertilite arzusu olan hastalarda, unilateral salpingoferektomi guvenle onerilebilecek bir tedavi seklidir.

OP20.06: The role of endometrial thickness on characteristics and adequacy of endometrial sampling procedure

This prospective, descriptive study included 115 consecu-tive patients requiring an ESP for different indications. All patientsunderwent a transvaginal ultrasound examination and endometrialthickness was measured. Thereafter ESP was performed by pipelle ingynecology outpatient clinic. The patients were divided three groupsaccording to ET measurement (group 1: ≤5 cm, group 2: 6–10 cm,group 3: ≥11 cm). The patients’ characteristics, ESP characteristicssuch as 10 cm Visuel anolog scala (VAS) for patients pain percep-tion during the procedure, 5 cm Likert scala for measure the easeof procedure, duration of the procedure, and adequacy endometrialsampling for histopathologic diagnosis were compared.

O124 INTRA UTERINE HEMOSTATIC SUTURE MAY PREVENT FROM HYSTERECTOMY IN PLACENTA ACCRETA AFTER THE PLACENTA REMOVAL

introduction of a new device. We designed the study to provide regular supervision, support and financial incentives to clinical staff. Nonetheless, we found it difficult to consistently collect high quality data and discovered many protocol violations. We addressed these challenges using continuous retraining on standard of care and study protocols, repetitive supportive supervision, strengthened monitoring and reporting systems, conducted realistic training drills, and gave continual feedback and supervisory support. While challenges remain, due to enhanced supportive supervision and monitoring we have collected reliable data on over 4100 women, with only 9% missed cases and 6 % dropped cases in the CRT. Conclusions: Rigorous conduct of CRTs in low resource settings is possible, but researchers/implementers need to be aware of and plan for multiple challenges and implement rigorous, creative supervisory and management interventions.