Mustafa Gazi Uçar

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.

Primary Ovarian Malignant Mixed Mullerian Tumour: A Case Report and Brief Review of Literature

Malignant Mixed Mullerian Tumour of the Ovary (OMMMT), also referred to as carcinosarcoma is a very rare tumour accounting for less than 1% of all ovarian cancers. Due to the rarity of OMMMT, little is known about the disease course and outcome of women with these tumours. It is important to evaluate because of its aggressive behaviour with extremely unfavourable prognosis. These tumours are composed of both malignant epithelial and mesenchymal elements. Current data in the literature is still limited to small case series and case reports, therefore, its optimal treatment is somewhat controversial. In the current report, we introduce a case of OMMMT which was successfully treated with Platinum-based combination chemotherapy after optimal cytoreductive surgery. The clinical manifestations, pathologic characteristics, diagnosis and management of these tumours are reviewed here. Although the most effective treatment is currently unknown, optimal cytoreductive surgery and platinum-based chemotherapy appears to improve the outcomes. Despite the aggressive nature of this tumour and its poor response to the treatment, management works best when cancer is found early. The stage of the disease is the most important prognostic factor. Therefore, the crucial question is how to diagnose the cancer at earlier stages rather than seeking the optimal treatment.

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.

Efficacy comparison of oral rosuvastatin versus oral progesterone and bevacizumab on regression of surgically endometriotic implants in rats

Abstract This study hypothesizes that oral rosuvastatin, oral dienogest and intraperitoneal bevacizumab might improve endometriosis in randomly selected female Wistar albino rats with surgically endometriotic implants. Thirty female Wistar albino rats with surgically endometriotic implants were randomized into three treatment groups: oral rosuvastatin (20 mg kg/day; oral rosuvastatin group 1; n = 10), oral progesterone (dienogest group 2; n = 10) and intraperitoneal bevacizumab (2.5 mg/kg of single intraperitoneal injection of bevacizumab; bevacizumab group 3; n = 10), for 10 days. Post-treatment variables were compared. The oral rosuvastatin group showed higher reduction for the glandular epithelium and uterine vessels of histopathological scores values than the oral progesterone group (both, p < 0.017, respectively). The median glandular epithelium and uterine vessels and histopathological scores values did not show a statistically significant difference between group 1 and group 3 (p > 0.017). Endometrial thickness values and uterine volume values were more significantly reduced in the oral rosuvastatin group than the oral progesterone group (both, p < 0.017, respectively). Moreover, endometrial thickness and uterine volume values were not different in groups wecompared with group 3 (p > 0.017). In conclusion, oral rosuvastatin and intraperitoneal injection of bevacizumab may cause more significant regression of surgically endometriotic implants in rats than oral progesterone medications.

Does lymphadenectomy have influence on postoperative body fluid distribution

OBJECTIVE We compared the fluid volume parameters in women undergoing gynaecological surgery for benign and malignant conditions before and after surgery using bioelectrical impedance vectors. STUDY DESIGN A total of 181 patients were enrolled. In all, 89 patients had surgery for benign conditions and 92 patients underwent oncological procedures, including lymph node dissection, for malignant diseases. Bioelectrical impedance analysis (BIA) parameters were measured on the day of hospitalisation before any treatment and at 24h and 1 month after the surgical intervention. The BIA parameters measured included extracellular water (ECW), intracellular water (ICW), and total body water (TBW). RESULTS TBW increased significantly 1 month after surgery in all cases (p<0,05 in both group). ECW was significantly higher (p<0.05) and ICW was significantly lower (p<0,05) in the malignant group than the benign group. CONCLUSION Radical gynaecological surgeries, including lymph node dissection, have a greater effect on body water distribution than surgeries performed for benign conditions.

A novel insight into the treatment of an intravesical eroded mesh: endoscopic-assisted cystoscopic approach.

Synthetic meshes are commonly used in urogynecologic procedures [1]. One such complication of mesh treatment is erosion into the bladder, a rare but serious event [2]. Once erosion involves the bladder, it necessitates its removal. Until now, various removal methods have been described, including transurethral, open, and laparoscopic; transvaginal; and combined approaches [1–3]. Conventional removal of eroded mesh is often done through a suprapubic cystostomy, with excision of the foreign material and closure of the bladder defect [3]. In an effort to reduce the morbidity of an open procedure, endoscopic techniques are introduced. Case study

The Prevalence of Hydatids of Morgagni in Surgically Managed Patients with Gynecological Conditions

ABS TRACT Objective: To determine the prevalence of hydatid of Morgagni (HM) and describe its clinical features in patients with gynecological conditions. Material and Methods: A prospective study was designed to investigate the prevalence of HM. The patients who underwent diagnostic or surgical procedures like laparotomy and laparoscopy to visualize the fallopian tubes for malignant or benign obstetrical/gynecological conditions at a tertiary referral health care from January 2015 to October 2016 were included in the study. We defined HM based on the direct visualization of the tubes at the time of surgery. Results: A total of 1,361 patients, 1,066 (78.3%) premenopausal and 295 (21.7%) postmenopausal, were included in this study. The mean age was 39.3 ±14.7 years (range 18–80 years). The overall prevalence of HM was 17.2% (n = 235) and that in premenopausal and postmenopausal women was 18.9% and 11.5%, respectively. HM prevalence was significantly higher among premenopausal women compared to postmenopausal women (p = 0.003). The majority (~96%) of the HMs were ≤ 1 cm and in only three cases (0.2%) the HM exceeded 2 cm in diameter. Conclusion: A systematic examination and appraisal of the adnexa during pelvic surgery may help in accurately identifying such common cysts. The direct evaluation of the fallopian tubes seems to be the best method to determine the prevalence of HM since most cysts are < 1 cm in diameter. Since the prevalence of HM decreased after menopause, their development may be stimulated by hormones.

An extremely rare case of complicated appendicitis: in utero appendix with fistula formation

A 43-year-old G4P4 woman was referred to our gynaecology clinic from emergency department with a right lower quadrant pain, bilateral pelvic tenderness, fever and signs of peritoneal irritation. She had no nausea, diarrhoea, constipation or other changes in bowel or bladder habits. She reports a gradual onset of symptoms of lower unilateral abdominal discomfort and abdominal cramping for 3 days. Discomfort has gradually worsened and pain tends to be accentuated by motion but did not improve with resting. Bimanual exam revealed uterine and adnexal tenderness, as well as pain with cervical motion. No abnormal vaginal discharge was present and qualitative B-hCG was negative. Significant laboratory values on admission were an elevated white blood cell count of 18 600/mL with a left shift and a C-reactive protein value of 88 mg/L. Sonographic imaging study of the pelvis revealed a normal sized uterus and a thick-walled unilocular cystic mass as fluid-filled structure; folded onto itself to form an ‘S’ shape in the right adnexal area. There was no free fluid in the pouch of Douglas. Based on the clinical findings and imaging studies, pelvic inflammatory disease (PID) was highly probable. After failed antibiotic therapy, the patient was scheduled for surgery 4 days after hospitalization. Patient was fully informed of the procedures and the possible risks of hysterectomy. Under general anaesthesia, vagina and abdomen were prepped and draped in the standard fashion. A Pfannenstiel incision was made. Surgical exploration revealed dense adhesions between uterus and appendix. Bilateral adnexa were normal. The appendix formed an S-shaped configuration and was noted to be enlarged, inflamed and adherent to uterine surface in its longitudinal plane (Fig. 1). The distal part of the appendix was embedded deeply into the uterus (Fig. 1). Local abscess and inflammatory process involving the entire anterior uterine wall were noted (Fig. 2). There were severe destructive effects of inflammatory reactions penetrating all layers of the uterus and permanently damaged areas. Patient who did not desire childbearing underwent an appendectomy and total abdominal hysterectomy. Patients had an uneventful post-operative period and she was discharged on day 5 following surgery. No delayed complications related to treatment and/or infection occurred during 6-month follow-up. Septic complications of acute appendicitis (AA) still pose multiple problems. Known potential complications of untreated or delayed management of AA include appendiceal perforation, periappendiceal abscess formation, peritonitis, bowel obstruction and rarely septic thrombosis of mesenteric vessels. The inflammation in AA may sometimes be enclosed by the patients own defence mechanisms, by the formation of an inflammatory phlegmon or a circumscribed abscess. In such cases, symptoms are dependent on the localization of the abscess and are often nonspecific. Thus, the correct diagnosis is usually not established until direct visualization at the time of surgery. Utero-appendiceal fistula is an extremely rare condition and this is the second case reported thus far. The first one was reported by Parsons et al. They reported a case with clinical and radiological evidence of pelvic sepsis and a medical history of endometrial ablation. On physical examination of our patient, pelvic and abdominal tenderness, pain with cervical motion and fever were noted. Presenting symptoms are similar to those of PID. Traditionally, it has been felt that the pathophysiological progressive nature of appendicitis ultimately leads to perforation. Abscess caused by perforated appendicitis and involving the tissues surrounding may be a contributory factor in fistula formation. A risk of full thickness uterine damage after endometrial ablation might be