Laparoscopically-assisted vaginal hysterectomy for enlarged uterus: operative outcomes and the learning curve

Objectives: The aim of the study was to compare the effects of uterine size and surgeon experience on the surgical out­comes of laparoscopically-assisted vaginal hysterectomy (LAVH) for benign gynecological conditions. Material and methods: This was a retrospective analysis of 184 LAVH cases. All hysterectomies were performed by the same surgeon and divided into two groups, with uterine weight of < 280 g (group 1) and uterine weight of > 280 g (group 2). The groups were compared in terms of the effects of the uterine size and surgeon experience vs. the operative outcomes (operative time, change in hemoglobin levels, hospital stay, and perioperative complications). Results: No significant differences in mean age, parity, history of chronic systemic diseases and previous surgery history were observed between the two groups. However, operative time was significantly greater in group 2 as compared to group 1 (132.1 ± 42.7 minutes vs. 111.5 ± 30.4 minutes, p < 0.05). There were no differences in the hospital stay and perioperative complications between the two groups. One case of bladder injury occurred in each group and one patient underwent a second laparoscopic surgery for postoperative bleeding in group 2. Greater surgeon experience was demonstrated to be associated with decreased operative bleeding and, consequently, smaller differences between preoperative and postop­erative hemoglobin levels. Operative time was also reduced as the surgeon was getting more experienced but the effect did not reach statistical significance. Conclusions: Our study supports the thesis that LAVH is a safe and effective procedure for managing benign gynecologi­cal conditions. Despite increased operative time, LAVH can be safely performed for enlarged uterus in conjunction with increased surgeon experience

Laparoscopic Cholecystectomy in Elderly Patients

Laparoscopic surgery can be safely applied in the elderly. Complications can be minimized by carefully selecting patients aged 80 years or older and operating on these patients with experienced teams with good technical capabilities

Comparison of transoral endoscopic thyroidectomy vestibular approach and open conventional thyroidectomy regardıng inflammatory responses, pain, and patient satisfaction: a prospective study

IntroductionThe application of transoral endoscopic thyroidectomy vestibular approach (TOETVA) is becoming widespread throughout the world. We primarily aimed to evaluate the severity of surgical trauma in TOETVA and conventional open thyroidectomy (COT) regarding the inflammatory response including the comparison of surgical stress markers [interleukin-6 (IL-6), C-reactive protein (CRP), white blood cell (WBC)].Material and methodThis non-randomized prospective study enrolled two groups with 20 patients each: COT group and TOETVA group. Patients aged 18–65 years with benign thyroid disease; with fine needle aspiration biopsy results of Bethesda III, IV or Bethesda V, VI (<1 cm nodule); thyroid volume <50 cm3; nodule diameter <4 cm; female gender without a previous neck, chin, and/or oral surgery; without vocal cord paralysis preoperatively; and patients in euthyroid state were enrolled to the study. Preoperative, postoperative second hour, first day, and second day CRP, WBC, and IL-6 levels were evaluated. Pain intensity was evaluated with the visual analog scale (VAS) score on the 2nd and 12th hour, 1st and 2nd days postoperatively.ResultsAll the patients were female and mean age was significantly higher in the COT group. The operative time was significantly longer in the TOETVA group. No significant difference was found between the two groups regarding IL-6 levels. In the TOETVA group, postoperative second hour WBC value (p = 0.044) and first (p = 0.002) and second day (p = 0.005) CRP values were significantly higher. In the TOETVA group, the lower lip and lower chin VAS scores were significantly higher at 2nd and 12th hour, on the first and second days. The anterior neck VAS score was significantly higher in the TOETVA group at the second hour (p = 0.025). General and cosmetic satisfactions were similar at the 15th and 30th days in both groups.ConclusionThe longer operative time and higher postoperative CRP level and VAS score in the chin and lower lip in the TOETVA group suggested that the method is not a minimally invasive technique compared to COT. However, the presence of similar total complication rates and early postoperative general and esthetic satisfaction that improves over time in both groups suggests that the clinical effect of increased magnitude of systemic inflammatory response in TOETVA might be temporary and acceptable

Turkey's Role in Energy Diplomacy from Competition to Cooperation: Theoretical and Factual Projections

This study aims to build up a conceptual framework for energy diplomacy together with examining the development of this concept in world politics. By using these, it attempts to analyse Turkey’s energy diplomacy practice. The study argues that energy diplomacy is an amalgamation of diplomatic methods for utilizing energy (reserves or transfer routes) for maximizing national energy interests in bilateral, multilateral, regional and global relations of energy demand and supply. In this respect, the variables for the formation and the implementation of energy diplomacy are analysed in worldwide historical basis and then with a particular focus on Turkey. Finally, the research focuses on the conditions that Turkey can utilize its energy diplomacy for collaboration, cooperation, and stability rather than struggle, confrontation or conflict. Keywords: Energy diplomacy; energy politics; energy competition JEL Classifications: F53; F55; N40; Q48

Development and in orbit testing of an x ray detector within a 2U cubesat

A CdZnTe based semiconductor X-ray detector (XRD) and its associated readout electronics is developed by the Space Systems Design Laboratory of Istanbul Technical University and High Energy Astrophysics Detector Laboratory of Sabanci University along with an SME partner. The detector will utilize 30 orthogonal cross strip electrodes (and 3 steering electrodes in between anodes) whose geometry is optimized by an extensive set of simulations and energy resolution measurements. The signals will be read by RENA 3b ASIC controlled by MSP 430 microcontroller. The system will have its own battery and will be turned on intermittently due to power constraints. CdZnTe based X-ray detectors have been utilized in space, but they are either pixellated (NuStar), or they consist of many individual crystal pieces (BAT in Swift satellite). The aim of the XRD is to show that large volume crystals with orthogonal strips are viable alternatives, especially for small satellite systems with medium energy resolution requirement. XRD will also characterize the hard X-ray background in 20-200 keV at low Earth orbit conditions as a function of altitude. Due to power and telemetry constraints, the individual events will be corrected for hole trapping on-board, histogrammed, and only the X-ray spectra will be transmitted to the ground station along with a small set of raw data for diagnostic purposes. The XRD is planned to travel into space, as a secondary science mission, on board BeEaglesat which is a 2U CubeSat developed as one of the possible double (2U) CubeSats for the QB50 project. QB50 is a European Framework 7 (FP7) project carried out by a number of international organizations led by the von Karman Institute of Belgium. Its main scientific objective is to study in situ the temporal and spatial variations of a number of key constituents and parameters in the lower thermosphere with a network of about 50 double and triple CubeSats, separated by few hundred kilometers and carrying a determined set of sensors