Mete Güngör

Laparoscopic near-infrared fluorescent imaging as an alternative option for sentinel lymph node mapping in endometrial cancer: A prospective study

BACKGROUND To evaluate feasibility of sentinel lymph node (SLN) mapping by using near-infrared fluorescent imaging and indocyanine green (NIR/ICG) integrated laparoscopic system in clinically uterine-confined endometrial cancer. MATERIALS AND METHODS Patients with clinically early-stage endometrial cancer were included in this prospective study. ICG was injected to the uterine cervix and NIR/ICG integrated laparoscopic system (Spies Full HD D-Light P ICG technology, Karl Storz, Tuttlingen, Germany) was used during the operations. SLN and/or suspicious lymph nodes were resected. Side specific lymphadenectomy was performed when mapping was unsuccessful. Systematic lymphadenectomy was completed following SLN algorithm steps. RESULTS Seventy-one eligible patients were analyzed. The overall, unilateral and bilateral SLN detection rates were 95.7%, 18.3%, 77.4%, respectively. There were 8 (11.2%) patients with lymph node metastasis. One of them was isolated para-aortic node metastasis. Negative predictive value, sensitivity and false negative rate for detecting lymphatic spread were 98.4%, 87.5% and 1.5%, respectively. CONCLUSION Sentinel lymph node mapping can easily be performed with high accuracy by using NIR/ICG integrated conventional laparoscopic system in endometrial cancer and almost all lymphatic spread can be detected.

Comparison of laparoscopy and laparotomy in surgical staging of clinical early stage endometrial cancer: A report of early experiences from Turkey

The objective of this study was to assess the feasibility of laparoscopy (LS) in endometrial carcinoma staging. Clinical early stage endometrial cancer patients (n = 153) staged by LS or laparotomy (LT) were compared. A total of 40 (26.1%) patients were treated by LS and 113 (73.9%) by LT. All patients underwent pelvic lymphadenectomy. Lymphadenectomy has been extended to para-aortic space in 55% of the LS group and 70% of the LT group. The majority of patients had stage I–II disease. The median numbers of removed pelvic and para- aortic lymph nodes were similar in two groups (p values 0.213 and 0.199, respectively). Body mass index (BMI) (kg/m2) was higher in the LT group (31.2 vs 27.4, p < 0.05). Operation time, age, tumour histology, para-aortic lymphadenectomy and complication rates were similar in the two groups. Four (10%) patients in the LS group and 12 (10.6%) in the LT group had recurrence of disease (p = 1.0). There was no statistical difference for overall survival between the two groups. In conclusion, these findings showed that in endometrial carcinoma cases, laparoscopy has provided adequate staging and similar survival rates with laparotomy.

Ovarian cystectomy for a dermoid cyst with the new single-port robotic system

Abstract We report a 27 year-old patient with a dermoid cyst who underwent robotic single port transumbilical ovarian cystectomy. She was operated through a 2 cm long single midline umbilical incision using a new platform from Intuitive Surgical. The operative time was 45 minutes and the docking time was 15 minutes. Ovarian cystectomy using the da Vinci single-port system is feasible and effective. This new semi-rigid robotic surgery platform may increase access to the potential advantages of single-site surgery. Robotic systems designed specifically for single port approach have the potential of alleviating several of the limitations associated with traditional laparoscopic single-site surgery.

The interval robotic transabdominal cerclage in a morbidly obese patient

The most commonly used prophylactic treatment of cervical insufficiency is cerclage but it carries significant morbidity either through vaginal or abdominal approach. A robotic-assisted transabdominal cerclage (RoboTAC) placement as an interval procedure could offer advantages over the conventional laparoscopic approach especially in morbidly obese patients. We report the use of interval RoboTAC procedure in a morbidly obese patient and ultimately she delivered a healthy infant at 38 weeks 2 days nonetheless removal of the cerclage.

The robotic metroplasty in a patient with hybrid septate variant anomaly.

Complete uterovaginal septum is unusually associated with an obstructed left hemivagina and hemiuteri. Herein we present a case report of “hybrid septate variant” anomaly diagnosed in a 16-year-old girl. The uterine septum could not be completely removed hysteroscopically because of the obstructed vagina and thick uterine septum; therefore an abdominal approach, robotic metroplastic surgery was performed. We propose that the robotic technology has advantages over the classical laparoscopy related with the surgical correction of Müllerian anomaly.

Diagnostic performance of p16 staining in atypical squamous cells ' cannot exclude high-grade squamous epithelial lesion ' in predicting high-grade cervical pathology

Abstract Atypical squamous cells ‘cannot exclude high-grade squamous epithelial lesion’ (ASC-H) cytology represents clear risk and has been a controversial issue in clinical practice. The objective of this study is to investigate the diagnostic performance of p16INK4A immunohistochemistry (IHC) among ASC-H Pap smears in predicting high-grade cervical intraepithelial lesions. Decolourisation and staining process with p16INK4A is applied to 27 ASC-H diagnosed conventional Pap smears, which were all managed with colposcopy-directed cervical biopsy priorly. Staining characteristics of ASC-H Pap smears were compared with histopathological data and sensitivity-specificity values of p16 triage to detect CIN2 + histopathology were determined. The sensitivity and specificity of positive p16INK4A immune staining to detect CIN2 + histopathology were as 87.5% and 68%, respectively. The positive predictive value of p16 triage is found as 53.8% and negative predictive value was as 92.8%. p16INK4A IHC seems applicable for conventional Pap smears and may provide an alternative triage option in ASC-H category.

Higher Level of Oxidative Stress Markers in Small for Gestational Age Newborns Delivered by Cesarean Section at Term

ABSTRACT Introduction: The aim of our study was to determine lipid peroxidation products and antioxidant enzyme activity in umbilical cord blood of small for gestational age (SGA) neonates. Materials and methods: Umbilical cord arterial blood samples were collected from 21-term singleton SGA newborn infants and 21 age- and sex-matched appropriate for gestational age (AGA) term neonates prospectively born by elective cesarean section for determination of malondialdehyde (MDA) as a marker of lipid peroxidation and superoxide dismutase (SOD) for antioxidant activity. Results: MDA levels were increased (5.20 vs. 3.52 nmol/mL; p < 0.001), while levels of SOD (6.24 vs. 8.99 U/mL; p < 0.01) were decreased in SGA neonates when compared with AGA newborn infants. Conclusions: Elevated MDA levels and decreased SOD activity in umbilical cord blood may show the possibility of insufficient protective mechanisms against increased oxidative stress in SGA neonates born by cesarean section.

Single-Port Robotic Practice

In the past 20 years, surgical techniques have moved toward a less invasive approach from open to single-incision minimally invasive surgery. Innovations in minimally invasive surgical technology, such as multichannel ports, articulating instruments, and flexible high-definition endoscopes, have allowed laparoendoscopic surgeons to perform increasingly complex surgeries through smaller incisions.