Single-port laparoscopic surgery for endometrial cancer: a systematic review

Purpose of Review This review aimed to provide an overview of single-port laparoscopic surgery and related literature. Based on previous reviews on endometrial cancer, we focused on the benefit of single-port laparoscopic surgery in endometrium cancer. Recent Findings Endometrial cancer is the most common gynecological cancer and can be treated with laparoscopic surgery without negatively affecting the oncological outcome. Single-port laparoscopic surgery is a recently emerging endoscopic technique, and it was shown that endometrial cancer could be staged using this method. Summary Research shows that endometrial staging with SILS is a feasible strategy that might become a common alternative to the conventional laparoscopic technique. In the future, this novel technique might take on a prominent role in advancing the evolution of minimally invasive gynecologic oncology surger

Comparative analysis of classical primary continuous and novel technique uterine suturing methods on uterine scar formation after caesarian section: a prospective clinical study

Objectives:  The study investigated isthmocele rate, residual myometrium thickness, blood loss, and closure lengths through comparing the classical primary continuous suturing (CPCS) and novel technique uterine suturing (NTUS) after caesarian section. Material and methods: A total of 402 C/S patients were included in this single-center prospective clinical study. All patients were divided into two groups according to suture technique. Classical primary continuous suturing (CPCS) was applied to the patients in Group 1, while the novel technique uterine suturing (NTUS) was applied in Group 2 as Z suture on both corners and 8 sutures in the remaining middle part incision closure. Results: Patients in the NTUS group bled less than in the CPCS groups (p < 0.0001). Incision length after closure was longer in the CPCS than in the NTUS (p < 0.0001). Similarly, the number of sutures we applied was higher in the CPCS (p < 0.0001). In comparison of residual myometrium thickness, the mean values measured 197 ± 50 mm in the NTUS and 146 ± 39 mm in the CPCS (p < 0.0001). Residual myometrium thickness showed a negative strong correlation with incision length after closure (r = –0.436; p < 0.0001), how many times the needles have been passed (r = –0.423; p < 0.0001) and time for suturing (r = –0.237; p < 0.0001). NTUS and CPCS groups were similar in comparison to isthmocele. Conclusions: The NTUS, termed as Erkayiran’s suture, showed a successful reflection in our surgical cesarean section application compared to the classical suture. Although the occurrence of isthmocele in patients was similar, results were quite successful operationally in terms of both minimal blood loss and increased residual myometrium thickness

A novel prenatal index predicting the probability of neonatal intensive care in pregnants: amnion progesterone receptor to alfa fetoprotein rate

Introduction: Amniocentesis (AC) is the most used interventional procedure for prenatal diagnosis. The study aims to evaluate the pregnancy outcomes undergoing AC and the potential of amnion progesterone receptor (aPR) to alfa fetoprotein (AFP) rate for predicting the probability of neonatal intensive care unit (NICU). Material and methods: This prospective cross-sectional study population consisted of 85 pregnant women who underwent mid-trimester AC. All cases were screened by ultrasound before AC. Maternal venous and amniotic samples were obtained simultaneously to evaluate the serum progesterone (sPRG), aPR, and aAFP and analyzed with patient results. Results: Unlike sPRG and aAFP, aPR showed a positive correlation with NICU and a negative correlation with parity. In linear regression, the aPR-AFP rate showed strong linearity with NICU and parity. In an aPR-AFP rate analysis, we saw a strong predictivity for NICU compared to the other three parameters. It presented 73.4% specificity and 79% sensitivity at 0.0075 cut-off (AUC: 0.78; p = 0.003; 95% CI: 0.608–0.914). Conclusions: Evaluating the PR either alone or in a rational combination with AFP will provide physicians with valuable information about the advanced process of pregnancy and postpartum complications. The physicians might use the aPR-AFP rate to predict NICU potential for pregnancy and need further studies to make more vital predictions on postpartum complications

Follicular flushing using double lumen needle yields more oocytes in mono-follicular poor responders

Objective: To compare the efficacy of follicular flushing (FF) with double lumen needle and direct follicularaspiration with single lumen needle in terms of oocyte yield in mono-follicular responder patients undergo ing assisted reproduction techniques (ART).Materials and Methods: Prospective ‘quasi-experimental’ study was carried out in an IVF center. Infertilewomen 18-42 years of age with diminished ovarian reserve who revealed a single follicle >17 mm on theday of oocyte retrieval were included in the study. Follicular flushing up to 8 times was performed in FFgroup using an 17-G double lumen needle. Direct follicular aspiration using a 17-G single lumen needle with out FF was performed in direct aspiration group. Total numbers of collected oocytes, metaphase 2 oocytes,fertilization and pregnancy rates were compared among groups.Results: A total of 206 women underwent oocyte retrieval procedure; 106 women were assigned to FF and 100women into direct aspiration arm. Overall oocyte retrieval rate was 50.4% in all cases. The total oocyte retrievalrate was higher (65/106, 61.9%) in FF group, than in direct aspiration group (39/100, 39%, p = 0.001). Metaphase 2oocyte rate was also higher in FF group (47/106, 44.3% vs 29/100, 29% p = 0.04). Fertilization rates, total number ofpatients with a cleavage stage embryo and grade 1 cleavage embryo were similar among the groups (p>0.5).Numbers of positive hCG, ongoing pregnancy and miscarriage rates were similar among groups.Conclusion: Follicular flushing using double lumen needle in mono-follicular responder patients with dimin ished ovarian reserve yields more oocytes and mature oocytes than direct aspiration of follicles

The relationship of renal pelvis diameters of fetus with pyelectasis observed with surgery requirements and neonatal complications in the postnatal period

To observe whether there is any difference in terms of postnatal complications and surgical requirements of fetuses with fetal pyelectasis in their antenatal follow-ups. A total of 199 patients were included in the study. Those with an anteroposterior renal pelvis diameter of 4 to 7 mm were included in the mild pyelectasis group (group1) (n=129), those with 7 to 10 mm in the moderate pyelectasis group (group2) (n=26) and those with 10 to 15 mm in the severe pyelectasis (group3) (n=44). Information such as delivery type, birth week, birth weight and gender of baby were recorded. The diagnoses and surgical requirement rates of babies followed up after birth were obtained from the case record files. Differences between both groups were evaluated. When the complications in the groups were examined, the differences between the groups with multicystic dysplastic kidney (p=0.011) and left ectopic kidney (p=0.028) were found to be significant. Left ectopic kidney was observed only in group3 at a rate of 4.5%. While ureteropelvic stenosis showed a significant difference in group2 and group3 (p<0.0001), this complication was not encountered in group1 at all. While vesicoureteral reflux was observed significantly in group2 and group3 (p=0.003), it was not observed in group1 at all. Normal US findings were detected in 95.3% of the patients and were evaluated as statistically significant (p<0.0001). According to all these data, the total need for surgical procedures in the distribution of postpartum surgical requirements of the groups was found to be 15.6%. No statistical significance was found between the groups according to the pyelectasis grade (p=0.235). Prenatal follow-up of the renal pelvis diameter and the follow-up of the patient in the postnatal period are extremely critical in terms of preventing the development of possible complications. The early diagnosis of pyelectasis ensures that the decision of follow-up and surgery is made within the framework of a regular follow-up

Can serum biochemical markers be used to establish a relationship between idiopathic polyhydramnios and antenatal aneuploidy?

Background: Polyhydramnios is a common cause of adverse pregnancy outcomes. The prediction of polyhydramnios in early pregnancy may lead to improved treatments and will diminish these adverse outcomes. Objective: This study aims to investigate the role of biochemical markers in antenatal screening tests to predict idiopathic polyhydramnios. Methods: Patient records were retrospectively evaluated in this case-control group study. Pregnant women (160 in total) were included in the study (this included 47 pregnant women diagnosed with idiopathic polyhydramnios and 113 healthy pregnant women as a control group). Results: Alpha-fetoprotein, unconjugated estriol, and total beta-human chorionic gonadotropin values were similar in both groups (p = 0.296, p = 0.573, p = 0.284). There was no significant difference between the group diagnosed with idiopathic polyhydramnios and the control group when the first-trimester screening test parameter, pregnancy-associated plasma protein-A, was examined (p = 0.102). Conclusion: Biochemical markers examined in prenatal screening tests in the first and second trimesters were insufficient to predict idiopathic Polyhydramnios. The reasons for this are that our study was retrospective, and the patient population was low. We believe that a prospective study with a larger population of patients should be conducted for more meaningful results

lodine levels in pregnant women with hyperemesis gravidarum

BJECTIVE: Iodine deficiency is a commonly seen problem and associated with pregnancy complica tions. In this study, we aimed to evaluate urinary iodine status in pregnant women with hyperemesis gravidarum STUDY DESIGN: A total of 121 women experiencing singleton pregnancies between 6 and 18 weeks of gestation were included in the study. The participants were divided into two groups; group 1 com prised 81 healthy pregnant women, and group 2 comprised 40 pregnant women with Hyperemesis Gravidarum. RESULTS: Urinary iodine levels were found to be significantly higher in healthy pregnant women than women with Hyperemesis Gravidarum (p=0.008). Urinary iodine was significantly correlated with the uri nary ketone (r= -0.252, p=0.005) and FT3 (r= -0.190, p=0.037). CONCLUSION: In pregnant women with hyperemesis gravidarum, oxidative stress was increased, uri nary iodine levels were significantly low and negatively correlated with disease severity. Thus, ıodine re placement might be essential to prevent pregnancy complications

A retrospective comparison of systemic and local methotrexate therapy applied before uterine curettage in caesarean scar pregnancy

This study aimed to evaluate the results of patients who were treated with different treatment modalities due to cesarean scar pregnancy in terms of treatment success, development of complications, and additional treatment need. Patients underwent dilatation-curettage (D/C) only group 1 (n=22), systemic methotrexate was applied on the first and fourth day and D/C was applied on the seventh day, group 2 (n=27) and those who received intracavitary methotrexate on the first day and D/C on the seventh-day group 3 (n=33) to be divided into three groups. The demographic information of the patients, length of stay, response to treatment, complication rates, and whether there was any difference in factors associated with the development of complications were compared between the groups. When the patients were evaluated, it was seen that those in group 2 had a lower gestational week (p=0.011). In addition, it was observed that the patients in group 2 had a significantly longer hospital stay (p0.05). In our study, we observed that the possibility of complication development among the three methods was less in patients who underwent intracavitary methotrexate, but we could not statistically determine that this situation was significant. We also found that the use of systemic methotrexate is the most disadvantageous method in terms of both the length of stay and the development of complications

Evaluation of visceral adiposity index with cardiovascular risk factors, biomarkers in postmenopausal women to predict cardiovascular disease: A 10 year study

Background and aim: Visceral adiposity index (VAI) is reportedly beneficial in predicting cardiovascular disease (CVD) and metabolic syndrome (MetS). However, long-term studies analyzing the efficacy of VAI in the pre-diction of CVD risk are limited. The relationship between VAI and electrolytes is unclear. This study aimed to determine if VAI can be used as a predictor of CVD and provide early diagnosis possibility for future CVD pa-tients. Moreover, the impact of biomarkers and electrolytes on VAI therefore indirect relation to CVD was analyzed.Methods: Postmenopausal women (aged >40 years) admitted to our hospital in 2011 were included and cate-gorized into two groups according to their VAI scores: mild/moderate and severe. Groups were compared with insulin resistance, biochemical parameters, and anthropometric measurements. Patients have been reached out after 10 years and questioned for additional disease and cardiovascular risk. Statistical Package for Social Sci-ences (SPSSv22.0) was used for data analysis. The p < 0.05 value was considered significant.Results: Mean VAI score of patients with MetS (7.30 +/- 4.75) was significantly higher than without MetS (2.95 +/- 1.05) (p < 0.01). Serum magnesium level was found significantly lower in the severe group. Serum zinc (Zn) and hsCRP levels were higher in the severe group. Correlation analysis showed significant positive correlations be-tween VAI scores and total cholesterol (r = 0.289, p < 0.05), Zn (r = 0.397, p < 0.01), fasting insulin (r = 0.455, p < 0.01) and no significant association with the 10-year CVD incidence (OR: 1.034 (0.888-1.203); p = 0.668).Conclusion: Previous VAI results cannot assist in predicting the 10-year CVD risk. Additionally, including mea-surements of serum Zn, total cholesterol, fasting insulin, and FBG levels are reasonable approach for managing postmenopausal women with unfavorable CVD risk profiles