Hüseyin Kıyak

Double notches: association of uterine artery notch forms with pregnancy outcome and severity of preeclampsia

Objective: To assess uterine artery Doppler waveforms and notches performed in the third trimester as a predictor of adverse outcomes. Methods: Of 490 preeclampsia (PE) patients between 24 and 34 weeks gestation, 166 were diagnosed with mild PE and 324 were diagnosed with severe PE. Patients were divided into four groups (no notch, a unilateral notch, bilateral notches and double notches). Results: Bilateral and double notches were predictive of shorter follow-up times, adverse laboratory outcomes, HELLP syndrome, prematurity, neonatal intensive care unit admission and perinatal mortality. Conclusion: Double notches represent progressive deterioration in the uterine artery and are predictive of adverse maternal outcomes.

Laparoscopic Excision of a Scar Pregnancy and Isthmocele Repair

STUDY OBJECTIVE Laparoscopic excision of a scar pregnancy and isthmocele repair with a barbed suture. DESIGN A step-by-step explanation of the laparoscopic excision technique of a scar pregnancy and isthmocele repair. SETTING Cesarean scar pregnancy occurs as a result of attachment of the products of conception to the uterine scar [1-3]. In the present case, a 34-year-old, gravida 4, para 1 patient with a history of 1 miscarriage and 1 ectopic pregnancy was diagnosed with type 2 cesarean scar pregnancy at 7 weeks of gestation. Dilation and curretage was performed at the 8th week of gestation to terminate the pregnancy. On ultrasonography performed 1 month later, placental material underlying the isthmocele was observed. Her beta human chorionic gonadotropin level was 13 836 mIU/mL. She was followed up for 1.5 months until the beta human chorionic gonadotropin levels were negative. However, the mass underneath the scar had grown larger, measuring up to 5 × 6 cm. Laparoscopy was performed because the patient reported vaginal spotting and pelvic pain. The incision was sutured with a synthetic absorbable unidirectional barbed suture (Stratafix Knotless Tissue Control Device; Ethicon Inc., Somerville, NJ). No residual scar defect was visible on follow-up ultrasonography 1 week and 1 month after surgery. CONCLUSION Barbed sutures ease the repair of uterine scar defects and can provide ideal reapproximation of thick myometrial tissue. Laparoscopic treatment of a scar pregnancy and isthmocele repair are effective and safe modes of treatment.

Single-layer versus double-layer closure of the vaginal cuff with barbed sutures in laparoscopic hysterectomy

OBJECTIVES The utilization of barbed sutures in laparoscopic hysterectomy has become popular among gynecologic sur-geons. Our aim was to compare the outcomes of two different techniques for closing the vaginal cuff with barbed sutures in laparoscopic hysterectomies. MATERIAL AND METHODS A retrospective study was completed on 202 patients who underwent laparoscopic hysterectomy for benign diseases at Istanbul Kanuni Sultan Suleyman Training and Research Hospital from April 2014 through June 2016. In group 1 (n = 139), a single-layer continuous suturing method was used; each bite contained the pubocervical fascia and vaginal mucosa anteriorly, and vaginal mucosa and rectovaginal fascia posteriorly. In group 2 (n = 63), a double-layer continuous suturing method was used; only vaginal mucosa was included in the first layer, and a second layer incorporated the pubocervical and rectovaginal fascias. RESULTS Patient characteristics (age, body mass index, parity, previous abdominal surgery, smoking, comorbidity) were similar between the two groups. There were also no differences in total operation time, length of hospitalization, intraop-erative complications, and perioperative change in hemoglobin levels. There was no difference between the two groups in terms of vaginal cuff dehiscence, which was the primary outcome measure of the study. Secondary outcome measures (presence of granulation tissue, spotting, cuff cellulitis) were also similar between the two groups. CONCLUSIONS We observed no differences in outcomes between single- or double-layer vaginal closure techniques with barbed sutures.

The outcomes of extending uterine incision transversely or cephalocaudally in patients with previous cesarean section: a prospective randomized controlled study

Objective: The comparison of intraoperative and postoperative outcomes of extending uterine incision transversely or cephalocaudally in patients with previous cesarean section. Methods: In our prospective randomized controlled study, we divided patients who undergone cesarean section in our hospital due to repeated cesarean indication between July 2014 and June 2015 into two groups according to the cephalocaudal or transverse extension of uterine incision. We recorded the demographic characteristics and intraoperative and postoperative data of all patients included in the study. We assessed the differences between cephalocaudal and transverse extensions of uterine incision as well as statistical data obtained. Results: We did not found any statistically significant difference between the groups in terms of bleeding volume, transfusion need, uterine artery damage, bladder damage, and atony development. We found that the incision extension was significantly low in those with cephalocaudally extended Kerr incision compared to the transverse group (p<0.05). Accordingly, we found that additional suture need was significantly lower (p<0.05). Conclusion: Extension on incision line and additional suture need are higher in the group with transversely extended uterine incision.

Laparoscopic Blinded Endometrial Cavity Resection for Robert's Uterus

STUDY OBJECTIVE To demonstrate that laparoscopic excision of the endometrial tissue of a blind endometrial cavity in a patient with a Roberts uterus who did not consent to hysteroscopic surgery due to her virgin state and religious beliefs was an effective alternative treatment option for progressive dismenorrhea and pelvic pain. DESIGN Presentation of a rare müllerian anomaly and a step-by-step demonstration of a laparoscopic excision technique in the endometrium of a blind uterine cavity (educative video) (Canadian Task Force classification III). SETTING Roberts uterus is a rare müllerian anomaly characterized by the presence of a blind endometrial cavity and an asymmetric septum. Endometriosis may be encountered in 40% of patients with this anomaly. A 15-year-old virgin patient with progressive dysmenorrhea was diagnosed with a Roberts uterus anomaly on magnetic resonance imaging. Hysteroscopic surgery was suggested to form a communication between the blind endometrial cavity and the hemiuterus; however, the patient refused to undergo any vaginal surgery due to her virgin state and religous beliefs. A decision to excise the endometrial tissue of the blind cavity laparoscopically instead of performing a hemihysterectomy was made to prevent any adverse effects on the ovarian blood supply and damage to the myometrial wall of the unicornuate uterus. INTERVENTION Laparoscopic resection of the blind endometrial cavity in a patient with a Roberts uterus anomaly. CONCLUSION Laparoscopic resection of a blind endometrial cavity is a safe and effective surgical alternative in patients who refuse vaginal surgery.

Safety and efficacy of using advanced electrosurgical bipolar vessel sealing during vaginal hysterectomy in morbidly obese patients: a retrospective cohort analysis

OBJECTIVES To assess the safety and efficacy of electrosurgical bipolar vessel sealing during vaginal hysterectomy in morbidly obese patients MATERIAL AND METHODS: A total of 105 morbidly obese patients who underwent vaginal hysterectomy due to benign gynecologic pathologies between January 2010 and April 2017 were included in the study. Patients were divided into two groups according to whether conventional suture ligation technique (n = 64) or electrosurgical bipolar vessel sealing (n = 41) were used during vaginal hysterectomy. The surgical procedure was performed with the same technique in both study groups. The primary outcomes were duration of surgery and estimated blood loss. The secondary outcomes were intra-operative complications and post-operative complications. RESULTS The duration of surgery and estimated blood loss in the vessel sealing group was significantly less than in the conventional suture group (p < 0.05). No significant difference was present between the two groups in the rate of intra-operative and post-operative complications. CONCLUSIONS The primary outcome of our study is that the EBVS system can be used equally and even more effectively in some aspects; and as safe an alternative approach to conventional suture ligation technique during vaginal hysterectomies performed specifically on morbidly obese patients with reduced operation times and blood loss, and without increasing the complication rates.