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, Ciğdem Kılıç, Caner Çakır, Günsu Kimyon Cömert, Taner Turan, Eylem Ünlübilgin, Nurettin Boran, Fulya Kayıkçıoğlu, Sevgi Koç
Journal of the Turkish-German Gynecological Association; https://doi.org/10.4274/jtgga.galenos.2021.2021.0001

Greg Marchand, Wesam Kurdi, Katelyn Sainz, Hiba Maarouf, Kelly Ware, Ahmed Taher Masoud, Alexa King, Stacy Ruther, Giovanna Brazil, Kaitlynne Cieminski, et al.
Journal of the Turkish-German Gynecological Association; https://doi.org/10.4274/jtgga.galenos.2021.2021.0057

, Sienna Anderson, Stacy Ruther, Sophia Hopewell, Giovanna Brazil, Katelyn Sainz, Hannah Wolf, Alexa King, Jannelle Vallejo, Kelly Ware, et al.
Journal of the Turkish-German Gynecological Association, Volume 22, pp 336-338; https://doi.org/10.4274/jtgga.galenos.2020.2020.0027

Abstract:
Trachelectomy is a notoriously difficult laparoscopic procedure secondary to remaining scar tissue from the prior supracervical hysterectomy, as well as the necessity to clear vital organs including the bladder and the rectum out of the plane of dissection in order to remove the cervix. Many authors have suggested techniques involving ureteral stents to minimize the chance of ureteral injury. Our institute presents this two-port laparoscopic technique without the use of stents which we believe safely accomplishes the trachelectomy through very minimally invasive means.
, , , Bekir Sıtkı Isenlik,
Journal of the Turkish-German Gynecological Association, Volume 22, pp 300-311; https://doi.org/10.4274/jtgga.galenos.2021.2020.0232

Abstract:
Ductus venosus blood flow velocity measurements are mandatory in many clinical indications. The evaluation of the flow is performed either by comparing the results with the reference tables or by checking the "a" flow qualitatively as reversed or absent in the spectral waveforms. It is aimed to develop the normal reference ranges in low-risk pregnancies of our population. Measurements of flow velocities (S, v, D, a) and indexes (PIV, PVIV, a/S, S/a) were performed by a single experienced specialist in 1279 singleton uncomplicated pregnancies between 11 and 40 weeks. The absolute flow velocities (S, v, D, a, Vm_Peak) and indexes (PIV, PVIV, a/S, S/a) are obtained from the spectral waveforms using the equipment producer's preset system. The still images were stored in the picture archiving and communication system. The predicted reference ranges of the DV blood flow velocities according to the gestational age are shown in tables and graphics. Predicted reference curves based on the 5th and 95th percentiles according to gestational week were plotted and given in tables and figures. The normal reference ranges for absolute flow velocities and indexes were studied in a tertiary care center. The measurements are performed by a single operator, a specialist certified by FMF, either in the classic patterns of the waveforms, about which there are several studies or in case of the variants of the spectral waveforms, which was published recently, for the first time in the medical literature.
Damaris Freytag, Göntje Peters, , , Nicolai Maass,
Journal of the Turkish-German Gynecological Association, Volume 22, pp 319-325; https://doi.org/10.4274/jtgga.galenos.2021.2021.0017

Abstract:
Endometriosis is one of the most common benign diseases in women of reproductive age. Nearly all gynecological offices and clinics are confronted with endometriosis; the frequency and severity of the disease vary from one setting to another. Adjoining specialties such as internal medicine, general medicine, surgery, urology, orthopedics, neurology and psychosomatic medicine are directly or indirectly confronted with various forms of endometriosis and its sequelae. The disease is marked by pelvic pain, dysmenorrhea, dyspareunia and sterility. Even in current times, several years elapse between the onset of the disease and its diagnosis. The diagnosis of endometriosis is rendered difficult by the fact that the symptoms may be very diverse. A precise documentation of the patient's medical history and thorough diagnostic procedures are essential to establish the disease. These will be described in the following.
Journal of the Turkish-German Gynecological Association, Volume 22, pp 279-285; https://doi.org/10.4274/jtgga.galenos.2021.2020.0171

Abstract:
To evaluate whether or not embryo transfer day has an effect on the rates of clinical pregnancy (CPR) and live birth (LBR) in in vitro fertilization-intracytoplasmic sperm injection (IVF-ICSI) treatment. A total of 757 patients who had undergone IVF-ICSI treatment between 2012 and 2017 were included in this study. The participants were stratified according to embryo transfer day as Group 1 (day 2 transfer; n= 43), Group 2 (day 3 transfer; n=633), and Group 3 (day 5 (blastocyst) transfer; n=81). Basal parameters and IVF-ICSI outcomes were compared between the groups. Groups 1 and 2 patients were older, had a higher BMI, worse responder rate, lower antral follicle count, lower peak E2 levels, and less endometrial thickness, and required an increased total gonadotropin dose than the other transfer day groups. In addition, the number of oocytes and MII oocytes, fertilization rate, and 2 PN were statistically different between the groups and the CPR (19.5% vs 36.9% vs 39.0%, respectively) and LBR (14.6% vs 30.4% vs 35.1%, respectively) were lower in group 1 than groups 2 and 3 (p<0.05). The grade I embryos were significantly higher in groups 1 and 2 with clinical pregnancy positive (OR=4.444; 95% CI 0.876-22.536; p=0.001 and OR=1.756; 95% CI 1.234-2.500; p<0.001) and live birth (OR=5.021; 95% CI 0.787-31.768; p=0.001 and OR=1.676; 95% CI 1.154-2.433; p=0.007). The data suggest that an earlier embryo transfer day has a negative effect on the clinical pregnancy rate. Older primary infertile women should not postpone their desire to have a baby because they are poor responders, and it should be explained that the chances of successful treatment are lower.
Erdal Şeker, Evindar Elçi
Journal of the Turkish-German Gynecological Association, Volume 22, pp 257-258; https://doi.org/10.4274/jtgga.galenos.2020.2020.0013

Abstract:
To show how interstitial pregnancy can be safely managed with a laparoscopic resection.
, , Tülin Söylemezoğlu
Journal of the Turkish-German Gynecological Association, Volume 22, pp 187-195; https://doi.org/10.4274/jtgga.galenos.2021.2020.0202

Abstract:
Placenta is a linking temporary organ that connects the developing fetus and the mother. However, it cannot avoid the embryo against chromium (Cr) and nickel (Ni) exposure. Quantification of Cr and Ni in biological and ecological subjects is challenging. Accordingly, the first goal of this study was to provide a validated Graphite Furnace Atomic Absorption Spectrometry (GFAAS) method to determine Cr and Ni in mother-newborn specimens. However, the main objective of this work was to assess the reference Ni and Cr contents in cord blood, maternal blood, and placenta samples. Biological samples were collected from 100 healthy mother-newborn pairs. Metal levels were quantified by the GFAAS method. Method validation of this toxicological analysis was performed by the use of certified reference materials (CRM), which was based on accuracy, precision, specificity, range, quantitation, and detection limits. Mean Cr levels of maternal blood, placentas, and cord blood were 0.337±0.222 μg/L, 0.221±0.160 μg/kg, 0.121±0.096 μg/L, respectively. Besides, mean Ni concentrations of these biological specimens were 0.128±0.093 μg/L 0.124±0.067 μg/kg, 0.099±0.067 μg/L, respectively. The method showed linearity with excellent correlation coefficients (r2) for Cr and Ni equal to 0.9994 and 0.9999, respectively. Satisfactory recovery and coefficient of variation (CV) for Cr and Ni were obtained as 102.85% and 102.35%; 1.75% and 2.91%, respectively. Relative error (RE) did not exceed 3%, demonstrating the accuracy of the method. Control charts were drawn to assess inter-day stability. Last but not least, the predicted reference ranges for Cr and Ni concentrations in maternal blood, placenta and cord blood were as follows: Cr 0.033-0.75 μg/L; 0.032-0.526 μg/kg; 0.031-0.309 μg/L and Ni 0.011-0.308 μg/L; 0.024-0.251 μg/kg; 0.066-0.209 μg/L, respectively. The reported reference values of biological specimens in this paper will provide complementary aid to health professionals in terms of assessment of environmental and occupational exposure.
Fuat Eserol, , Aslı Nehir Aytan, Ali Celik, Engin Celik, ,
Journal of the Turkish-German Gynecological Association, Volume 22, pp 206-211; https://doi.org/10.4274/jtgga.galenos.2021.2020.0136

Abstract:
Hysteroscopy is frequently performed in infertile women and thought to improve pregnancy rates. The data obtained from studies searching the effect of hysteroscopy in in-vitro fertilization (IVF) cycles is variable. We aimed to evaluate the effect of hysteroscopy on the pregnancy outcomes of fresh and frozen-thawed embryo transfers done in the IVF cycles respectively. We scanned the data of the 765 patients who had IVF treatment between January 2015 and July 2017 in an infertility center retrospectively. Of those, 586 patients were done fresh embryo transfer, 179 patients were underwent frozen-thawed embryo transfer (FET). Hysteroscopy was scheduled 2 months before the transfer by a single experienced surgeon. 101 patients in the fresh embryo transfer group and 44 patients in the FET group were underwent hysteroscopy. The pregnancy outcomes of the groups were compared respectively within their own group. The mean age was similar in patients within in the fresh and frozen-thawed embryo transfer groups (p= 0.418 and p=0.277, respectively). There was no statistically difference according to transferred embryo numbers in the fresh and frozen-thawed groups (p=0.218). We achieved 246 pregnancy in the fresh embryo group (44 patients were underwent diagnostic hysteroscopy while 202 did not, p= 0.516) and 79 pregnancy in frozen-thawed embryo group (20 patients were underwent diagnostic hysteroscopy while 59 did not, p= 0.711). There was no statistically difference according to pregnancy rate between the groups (p= 0.538). Performing diagnostic hysteroscopy before fresh or frozen-thawed embryo transfer does not improve the pregnancy rates.
, Casey Richardson, Kyle R. Mackeya, Karen H. Hagglund, Muhammad Faisal Aslam
Journal of the Turkish-German Gynecological Association, Volume 22, pp 174-180; https://doi.org/10.4274/jtgga.galenos.2021.2021.0032

Abstract:
To determine whether ventral mesh rectopexy at the time of sacrocolpopexy reduces the rate of future posterior wall prolapse. This is a retrospective cohort study of 150 women with pelvic organ prolapse (POP) who underwent sacrocolpopexy with (n=41) and without concomitant rectopexy (n= 109) at a single community hospital from December 1, 2015 to June 30, 2019. Preoperative Pelvic Organ Prolapse Quantification (POP-Q) and urodynamic testing was used in evaluation of pelvic organ prolapse. Patients were followed for 12-weeks postoperatively and a 12-week postoperative POP-Q assessment was completed. The incidence of new or recurrent posterior prolapse was compared between cohorts. Patient demographics did not statistically differ between cohorts. Post-surgical posterior wall prolapse was reduced in the robotic assisted sacrocolpopexy (RASC) + rectopexy group compared to RASC alone, however this did not reach statistical significance. There were no patients who underwent concomitant rectopexy and RASC that needed recurrent posterior wall prolapse surgery, compared to eight-percent of patients that underwent isolated RASC procedures. Our findings suggest a reduction in the need for subsequent posterior wall surgery when rectopexy is performed at the time of sacrocolpopexy. In our study, no future surgery for POP was found in the concomitant sacrocolpopexy and rectopexy group, while eight percent of the RASC only group required future POP surgery. Our study, however, was underpowered to elucidate a statistically significant difference between groups. Future studies are needed to confirm a reduced risk of posterior wall prolapse in patients who undergo concomitant RASC and rectopexy.
, , Fırat Ortaç
Journal of the Turkish-German Gynecological Association, Volume 22, pp 242-248; https://doi.org/10.4274/jtgga.galenos.2021.2021.0025

Abstract:
Lymph node metastasis both upstages the disease and alters adjuvant treatment plans in gynecologic cancers. Since minority of the patients have nodal metastasis, many patients unnecessarily undergo complete lymphadenectomy and face its morbidities. Sentinel lymph node (SLN) mapping is an alternative for evaluation of lymph nodes with lesser side effects. Although it is yet an experimental approach in ovarian cancer, it has been incorporated into guidelines for endometrial, cervical and vulvar cancers. We aimed to summarize the current situation of SLN mapping in gynecologic cancers.
Baki Erdem, Lale Karakış, Osman Aşıcıoğlu, Hüseyin Kıyak, Gülseren Yılmaz
Journal of the Turkish-German Gynecological Association, Volume 22, pp 259-261; https://doi.org/10.4274/jtgga.galenos.2020.2020.0092

Abstract:
Unicentric Castleman disease (UCD) is a rare disease of the lymph nodes with unknown etiology, most commonly presenting as localized asymptomatic adenopathy incidentally discovered on radiographic imaging. The retroperitoneum is a rare site for UCD, where it can mimic malignant tumors. Complete surgical resection with disease-free margins is considered both diagnostic and curative. However, this may be challenging due to the high vascularity and close proximity of UCD to major vessels. A 42-year-old patient with a 46x44x26mm mass in the aortocaval area at the level of the renal pelvis underwent surgery with the suspicion of metastatic lymphadenopathy. Laparoscopic excision of the mass was carried out and the histopathological examination revealed the presence of UCD. This video article aimed to demonstrate the surgical steps and techniques used to minimize hemorrhage during dissection of UCD. Laparoscopy is safe and effective in the diagnosis and treatment of UCD, provided the operating surgeons have a thorough knowledge of abdominal anatomy and are aware of the functions and limitations of surgical devices used during laparoscopy.
, Kübra Murzoğlu Altıntoprak, Hatice Özge Çiftçi, , , , Nuri Çagatay Çimşit
Journal of the Turkish-German Gynecological Association, Volume 22, pp 196-205; https://doi.org/10.4274/jtgga.galenos.2021.2020.0215

Abstract:
To describe the radiological features, diagnostic accuracy and features of imaging studies and their relation with clinical course of coronavirus disease 2019 (COVID-19) pneumonia in pregnant women. The clinical, laboratory and radiological features of symptomatic pregnant women suspected for COVID-19 were retrospectively reviewed. Chest radiography (CXR) and chest CT findings of COVID-19 in pregnant women were identified. Fifty-five of eighty-one pregnant women were included in the final analysis. The most common admission symptoms were dry cough (45.4%), fever (29.1%) and dyspnea (34.5%). Radiological imaging studies were performed to 34 (61.8%) patients. Fourteen (66.7%) of the laboratory-confirmed COVID-19 patients had parenchymal abnormalities in CXR, and most common abnormalities were airspace opacities (61.9%) and prominent bronchovascular shadows (28.6%). Seventeen (85.0%) of the patients had parenchymal abnormalities consistent with COVID-19 in their chest CT. Chest CT most commonly showed bilateral (88.2%), multilobe (100%) involvement; peripheral and central distribution (70.6%); patchy-shape (94.1%) and ground-glass opacity (94.1%). The sensitivity of CXR and chest CT was calculated as 66.7% and 83.3%, respectively. Preterm birth rate was 41.2% (n = 7/17). Five (9.1%) of the 55 pregnant women admitted to the intensive care unit, three of those developed acute respiratory distress syndrome (ARDS) and one of them died. This study describes the main radiological features of symptomatic pregnant women infected with COVID-19. The refusal rate among pregnant women for the imaging modalities involving ionizing radiation was high. The preterm birth and cesarean section rates were observed as remarkably increased.
Journal of the Turkish-German Gynecological Association, Volume 22, pp 255-256; https://doi.org/10.4274/jtgga.galenos.2019.2019.0121

Abstract:
Fertility-sparing surgery has a popularity in the last three decades for the management of cervical cancer in women under 40 years of age. Radical trachelectomy is a fertility‐sparing surgical technique for women who wish to retain their fertility. Vaginal-assisted laparoscopic radical trachelectomy is feasible in selected patients with early cervical cancer. The aim of this video is to present a nerve-sparing vaginal-assisted laparoscopic radical trachelectomy demonstrating pelvic anatomical structures.
Journal of the Turkish-German Gynecological Association, Volume 22, pp 217-234; https://doi.org/10.4274/jtgga.galenos.2021.2020.0197

Abstract:
Gestation weight (GW), body mass index (BMI), and the blood 25-hydroxyvitamin D (25(OH)D) level during pregnancy are important determinants of the gestational outcomes. This study aims to study how these parameters vary between antenatal vitamin D recipients and non-recipients in gestational diabetes mellitus (GDM) patients. The randomized controlled trials comparing these outcomes between vitamin D recipient and non-recipient GDM patients were searched in electronic databases (PubMed, Embase, and Scopus). The reviewed studies' data were abstracted and critically appraised by the Cochrane tool. The estimation of the weighted mean difference for GW and BMI and standardized mean difference (SMD) for 25(OH)D levels occurred by juxtaposing the interventions meta-analytically (random-effect model). The statistical inconsistency was determined by Chi2 and I2 method. The statistical significance was estimated at p<0.05 and 95% confidence interval (CI). Eleven eligible trials (all Iran-based, except one) sourcing data from about 875 GDM patients were reviewed. Overall, the risk of bias was low, except for selection and performance bias. On random-effect model meta-analysis, the 25(OH)D levels of the GDM patients favored the vitamin D recipients when compared to non-vitamin D (SMD: 1.97, 95%CI, 1.06, 2.88, p, <0.001, I2, 96.2%, p of Chi2, <0.001) and placebo (SMD, 1.86, 95% CI, 0.95, 2.77, p,<0.001, I2, 95.3%, p of Chi2,<0.001) recipients, respectively. On meta-regression, sample size was a predictor of the observed heterogeneity. For GW and BMI the interventions did not differ statistically significantly. In GDM patients, antenatal use of vitamin D aids in the rise of blood 25(OH)D levels; however, it doesn't influence GW and BMI change. PROSPERO registration number: CRD42020149613.
Ahmad Badeghiesh, Rea Konci, , Weon-Young Son,
Journal of the Turkish-German Gynecological Association, Volume 22, pp 168-173; https://doi.org/10.4274/jtgga.galenos.2021.2020.0207

Abstract:
To compare outcomes transferring one or two embryos in autologous frozen oocyte cycles. A retrospective cohort study conducted at an academic fertility center (January 2012 and December 2018). 114 patients underwent frozen oocyte transfers. 67 patients underwent SET and 47 underwent DET. No subjects had more than DET during the time period of study. Data were analyzed using t test and chi-squared testing. Multivariate logistic regression was used to control for confounding effects. Power analysis suggested an 82% power with alpha of 5% and effect size of 27%. Regarding the stage, 72 % were cleavage embryos and 28% were blastocyst embryos. Among those who had cleavage stage embryos, 48.8% had SET and 51.2% had DET. In the blastocyst embryos, group 84.4% had SET and 15.6% had DET. There were no statistical differences observed in pregnancy rate for SET (40.3%) vs. DET(36.2%) (P = 0,78). Additionally, the live birth rate was not different between SET (28.4%) & DET(19.1 %) (P= 0.26). The multivariate multilevel analysis provided an adjusted OR- [95% CI] of 1.85-[0.46 - 7.44] for pregnancy, 0.497-[0.05 - 4.86] for clinical pregnancy, and 0.82-[0.11 - 6.29] for live birth when comparing SET & DET. Multiple pregnancy rates were significantly lower in the SET (0%), compared with DET group (44.4%) (p< 0.002). There are excellent live birth outcomes returning single embryos in autologous frozen oocyte cycles. However DET results in significantly increased rates of multiple pregnancies. As such SET is a viable option in autologous frozen oocyte cycles.
, Sezcan Mümüşoğlu, Neslihan Coşkun Akçay, Ayten Sever, Hande Yeğenoğlu, , Lale Karakoç Sökmensüer
Journal of the Turkish-German Gynecological Association, Volume 22, pp 181-186; https://doi.org/10.4274/jtgga.galenos.2021.2020.0168

Abstract:
To investigate the effect of using granulocyte-macrophage colony-stimulating factor (GM-CSF) containing culture media on embryological data and reproductive outcomes in patients with early embryonic developmental arrest. Retrospective case-control study. A total of 39 patients, whose embryos were incubated with GM-CSF containing culture media due to embryonic developmental arrest in two previous IVF cycles in-between January 2016 and November 2017 at … University IVF center, were enrolled. Control group was generated among patients with first IVF attempts due to tubal factor in the same time period. All embryos in the control group were incubated with single step culture medium (without GM-CSF). For the control group selection, matching was done 1:2 ratio considering female age, body mass index, number of M-II oocyte retrieved, and number of embryo transferred (n=80). Demographic features and embryological data were comparable between two groups. Number of fertilized oocytes (2-pronuclear) was 3.7±2.0 in GM-CSF group and 3.9±2.5 in the control (p= 0.576). Overall, number of embryos transferred (1.3±0.5 vs. 1.3±0.5, respectively) and blastocyst transfer rate (67.6% vs. 59.2%, respectively; p=0.401) were similar. For the reproductive outcomes, implantation rate (32.3% vs. 33.1%, respectively; p= 0.937), clinical pregnancy rate (33.3% vs. 32.5%, respectively; p= 0.770), and live birth rate (LBR) (25.2% vs. 26.2%, respectively; p= 0.943) were similar. Using GM-CSF containing culture media in patients with previous two failed IVF attempts due to embryonic developmental arrest might rectify embryological data and reproductive outcomes. To make solid conclusion further randomized controlled trial is warrant.
Mete Işıkoğlu,
Journal of the Turkish-German Gynecological Association, Volume 22, pp 235-241; https://doi.org/10.4274/jtgga.galenos.2021.2020.0222

Abstract:
Collecting and reporting data is a crucial aspect of IVF practice. During the following two decades after the first report of European IVF-monitoring Consortium (EIM) on IVF data, the number of contributing countries increased gradually reaching nearly fourty. In 2004 for the first time Turkey took part in European registry and accordingly in World registry. Starting the submission of Turkish data to EIM was an important milestone since Turkey appeared as the sixth country in relation to the number of cycles performing nearly eight percent of all European ART cycles. Turkey continued contributing to European registry for the following four years consecutively but after 2008 the input of Turkish IVF data stopped again. Strikingly, between 2004-2008 Turkey became one of the main contributors of the registry with an ability to give a full report. So far, we do not have a complete European set of data and the number of cycles reported by ESHRE EIM can easily be said to be an underestimation of the actual number of cycles. The IVF data of Turkey - a country having the seventeenth highest population in the World and appearing among the first six countries in Europe in terms of the number of ART cycles per year- will definitely contribute very much to ESHRE EIM database. Then, it is time to turn the tide and restart submitting the data to European registry, but this time regularly in a systematic method. Such an achievement will greatly contribute to the aim of EIM of achieving a complete data set.
, , Atahan Toyran, Ilkan Tatar, , Deniz Demiryurek
Journal of the Turkish-German Gynecological Association, Volume 22, pp 253-254; https://doi.org/10.4274/jtgga.galenos.2019.2019.0117

Abstract:
Paraaortic lymph nodes are exclusively important in staging of gynecologic malignancies. This surgical education video describes the step by step technique of paraaortic lymphadenectomy with anatomic landmarks on a cadaver.
Ana Luzarraga Aznar, Pia Español Lloret, Cristina Soler Moreno, Rocio Luna Guibourg, Ramon Rovira Negre
Journal of the Turkish-German Gynecological Association; https://doi.org/10.4274/jtgga.galenos.2021.2021.0028

Abstract:
Description of laparoscopic management for symptomatic pelvic lymphocele after surgical staging in gynecological cancer surgery and demonstrate its feasibility. Step-by-step description of the surgical procedure using pictures and an educational video. Informed consent was obtained for the use of images, and the full video article was approved by the Institutional Review Board of the Hospital of Sant Pau. Lymphocele is one of the most common complications of pelvic or lumbo-aortic lymphadenectomy. Although its incidence is about 1-58% (1), around 5-18% of them are symptomatic. Only symptomatic lymphoceles require treatment as medical or interventional approach. Drainage is usually performed by guided radiology although surgical approach has shown a lower rate of recurrence. A 64-years-old woman with diagnosis of endometrial carcinosarcoma was staged laparoscopically by pelvic and para-aortic lymphadenectomy. Para-aortic lymphadenectomy was performed by extraperitoneal approach. Three weeks later she presented with an intense and persistent burning pain irradiated toward left leg. CT scan revealed two images suitable with the presence of a 10 x 7,6 cm lymphocele adjacent to left external iliac vessels. Laparoscopy was performed with four-port placement configuration, enabling the recognition of a big bi-lobulated lymphocele adjacent to left pelvic wall and left paracolic gutter. Adhesiolysis and identification of main landmarks in left paracolic gutter and left paravesical fossa was performed as a first step. Peritoneum of each lymphocele was opened in their caudal part and the opening was broadened to facilitate the lymph drainage. Owing the little morbidity and the excellent results, laparoscopic drainage should be performed as a feasible and useful treatment for pelvic symptomatic lymphoceles.
Kerem Doğa Seçkin, Pınar Kadiroğulları, Hüseyin Kıyak, Ali Rıza Doğan, Ömer Lütfi Tapısız
Journal of the Turkish-German Gynecological Association; https://doi.org/10.4274/jtgga.galenos.2021.2021.0029

Abstract:
This video will demonstrate a minimally invasive technique, in which the Manchester procedure was combined with laparoscopic sacrohysteropexy by retroperitoneal tunneling in patients with uterine prolapse and cervical elongation who wished to preserve the uterus. The principle steps and techniques to complete the operation are dictated in the video. The prolapse surgery was performed uneventfully, and the uterus was restored to its anatomical position. During the two years of follow-up, there were no complications from the prolapse or mesh-related events. No prolapse recurrence was observed. This technique facilitates uterine-sparing surgery, results in less bleeding and shorter operative time (1), and we believe that it may reduce the recurrence of prolapse due to the elongation of the cervix.
Fatih Kılıç, Günsu Kimyon Cömert, Serra Akar, Ciğdem Kılıç, Caner Çakır, Dilek Yüksel, Mehmet Ünsal, Nedim Tokgözoğlu, Salih Taşkın, Tolga Taşçı, et al.
Journal of the Turkish-German Gynecological Association; https://doi.org/10.4274/jtgga.galenos.2021.2021.0072

Abstract:
We aimed to evaluate the clinico-pathological patient features, prognostic factors, treatment options and outcomes of peripheral nodal recurrence (PNR) of endometrial cancer (EC). The data of 9 patients with PNR of EC from two institutions were reviewed. The electronic literature was reviewed from 1972 to May 2018 to identify articles about PNR in EC. Finally, 42 cases were evaluated. 19 (45.2%) patients were initially diagnosed with either stage I or II disease, whereas 20 (47.7%) patients had stage III or IV disease. The stages were not reported in 3 patients. PNR developed as the first recurrence in 40 (95.2%) patients and as the second recurrence in 2 (4.8%) patients. Isolated PNR appeared in 35 (83.3%) patients. Seven (16.7%) patients had PNR coexisting with multiple other sites of tumoral involvement. In the entire cohort, the 5-year and 10-year post-recurrence survival (PRS) were both 78%. Only the presence of distant hematogenous metastasis concurrent with PNR was significantly related to poor PRS (p=0.005). Among patients with isolated PNR, those who had surgery had 30% higher 5-year PRS than those treated without surgery, however, this difference was not found as statistically significant (80% vs. 50%; p>0.05). A concurrent distant hematogenous metastasis was the only factor related to poor survival. A wide range of therapies exist for PNR but none of the therapies appear to be more advantageous over others. However, surgery as a component of treatment can render a survival advantage for patients who have isolated PNR.
Cuesta Guardiola Tatiana, Quiros Carretero Alicia, Martinez Martinez Javier, Pereira Sánchez Augusto, Cuñarro López Yolanda, De Leon-Luis Juan Antonio
Journal of the Turkish-German Gynecological Association; https://doi.org/10.4274/jtgga.galenos.2020.2020.0120

Abstract:
The diagnosis of endometrial cancer is made by biopsy sampling with pathological analysis, but it is extremely important to make an accurate diagnosis in order to plan the specific treatment, and we suggest that HE4 in the endometrial tissue and in serum could be tools to make the diagnosis more precise. Our prospective study compared patients with endometrial cancer against non-endometrial cancer ones, matched with several variables. The inclusion criteria were females older than 18 years old that accepted to participate in the research study but that had never underwent surgery for other oncological pathologies, whether for ovarian, colon, cervical carcinoma or uterine sarcoma, and none of them had received preoperative chemo or radiotherapy; moreover, they could not have any severe renal or liver pathology. All of them had hysterectomy surgery and the endometrium was studied by a pathologist who compared the regular staining with HE4-antibody staining, in addition, there were collected the serum samples previous to the surgery. Suggest bad correlation between the tissue HE4 in patients with and without carcinoma, however, the serum HE4 is statistically significant in the diagnosis of endometrial carcinoma (median EC= 123.1 U, median NE=64.67 U, p=0.002), although the CA125 level is not significant (p=0.208). Compared to previous studies our results are quite different in the pathological side, but the serum conclusions are positive and very hopeful as the tumor marker HE4 seems to be able to diagnose endometrial cancer.
, Başak Balaban, Bülent Urman, Kayhan Yakın
Journal of the Turkish-German Gynecological Association; https://doi.org/10.4274/jtgga.galenos.2021.2021.0016

Abstract:
The assessment of the optimal number of follicular flushing on retrieval rate and quality of oocytes in mono-follicular IVF cycles. This is a retrospective analysis of 246 oocyte pick-up procedures in mono-follicular IVF cycles of 226 poor responder women. The primary endpoint was oocyte retrieval rate in the initial aspirate versus subsequent flushing episodes. The secondary endpoints were oocyte maturity, fertilization rates and embryo cleavage. The procedure was successful in 187 cycles (76%), out of which 160 M-II oocytes were retrieved. Retrieval rates were similar for natural and modified natural cycles (p=0.595). The initial aspirate provided 54% of the total yield and the rest was obtained from up to four episodes of flushing. Follicular flushing increased oocyte recovery rate from 41.1% to 76%. None of the oocytes retrieved after three flushes fertilized. Oocyte maturity, fertilization and embryo cleavage rates were comparable for oocytes from the initial aspirate and one to two episodes of flushing. Oocytes obtained after the third flushing episode developed into poor quality embryos. Flushing confers a benefit in mono-follicular IVF cycles in poor responder women but flushing more than four times is futile.
Eren Akbaba, Burak Sezgin, Ahmet Akın Sivaslıoğlu
Journal of the Turkish-German Gynecological Association; https://doi.org/10.4274/jtgga.galenos.2021.2020.0242

Abstract:
Uterine fibroids are common benign uterine tumours. The three most common surgical treatment approaches for uterine fibroids are laparoscopic, robotic and abdominal myomectomies. Bleeding is a risk with all three approaches. The present study compared post-operative and pregnancy outcomes in patients with bilateral uterine artery occlusion who underwent an abdominal myomectomy, with or without a temporary uterine tourniquet. This retrospective study included 84 patients with intra-mural fibroids (≥ 5 cm) who underwent an abdominal myomectomy. The patients were divided into two groups according to the use (n = 36) or non-use (n = 48) of a temporary uterine tourniquet, and post-operative and pregnancy outcomes in the tourniquet use and non-use groups were then compared. The association of uterine fibroid removal number (≤ 3 and > 3) with laboratory parameters were also evaluated. There was a statistically significant difference between the groups with > 3 myomas removed and with a uterine tourniquet applied and not applied in terms of haemoglobin (Hb) drop, haematocrit (Hct) drop, transfusion amounts, operation times and lengths of hospitalization in favour of the uterine tourniquet use group (p = 0.019, p = 0.023, p = 0.012, p = 0.044 and p = 0.036, respectively). Bilateral uterine arterial occlusion using a temporary uterine tourniquet had no negative effects on pregnancy outcomes. A temporary uterine tourniquet may be an effective method for reducing the amount of perioperative bleeding in patients with multiple, large-sized myomas located close to vascular structures.
Berna Dilbaz, Mehmet Bülbül, Serdar Dilbaz, Nafiye Yılmaz, Sema Sanisoğlu
Journal of the Turkish-German Gynecological Association; https://doi.org/10.4274/jtgga.galenos.2021.2021.0004

Abstract:
The aim of this study was to evaluate the efficacy, side-effects and continuation rate of the desogestrel-progestin-only-pill (POP) in postpartum and post-abortive Turkish women its relation with breast-feeding. In this prospective multicentric study women who delivered (or had surgical abortion) and wanted to receive POP for contraception were recruited to the study. The follow-up visits were scheduled at 3rd, 6th and 9th months. Overall 7468 women (66.5% postpartum, 33.5% post-abortive) participated in the study. According to the previous visit, the percentage of women who came for a follow-up visit at 3rd, 6th and 9th month was 944(12.6%), 406(43%) and 121(29.8%) respectively. Out of the 7468 women recruited only 6% continued with the method at the end of the 9th month. There was a statistically significant increase in Hb level at the 3rd month when compared to the initial values. The incidence of breastfeeding at all visits was between 54.8% and 68.4%. Oligomenorrhea, spotting and headache were the three leading side-effects. There was no pregnancy among the patients who were followed up. This study demonstrates that POP is an effective postpartum and post-abortive contraceptive method that has no negative impact on breast-feeding and the change in bleeding patterns is the most common side-effect. However, the possible causes of low contraceptive maintenance rates need to be investigated.
Kobra Tahermanesh, Soheil Hanjani, Roya Shahriyari, Abbas Fazel Anvari-Yazdi, Leila Allahqoli, Ibrahim Alkatout
Journal of the Turkish-German Gynecological Association; https://doi.org/10.4274/jtgga.galenos.2021.2021.0006

Abstract:
Modern surgical technologies allow gynecologists to treat most submucosal myomas by some form of resection hysteroscopically. What appears on imaging or direct visualization to be a submucosal myoma can be a single tumor, or may represent multiple smaller myomas appearing as one, compacted together in a typical pseudo capsule. During myoma resection, the effect of the distending media can be different depending on the morphology of the myomas. After starting resection, the power of distending media can push truly solitary myoma to somewhat flatten against the uterine wall. However, in the second type of myoma, the fluid can push the myomas into the uterine cavity, similar to the blooming of a flower. The tip of the hysteroscope may enter the dissected spaces between the myomas, impairs the panoramic view. This event can be a cause of failure of hysteroscopic myomectomy to adequately treat the myomas encountered. In this study, blooming phenomenon is introduced, the problems created by this phenomenon and solutions for its management are considered.
, Alperen Aksan
Journal of the Turkish-German Gynecological Association, Volume 22, pp 139-148; https://doi.org/10.4274/jtgga.galenos.2021.2020.0133

Abstract:
Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) are characterized by somatic and psychologic symptoms that arise at the luteal phase of the menstrual cycle and subside with menstruation. For definitive diagnosis prospectively self-reported symptoms should demonstrate a cyclic pattern and other psychological pathologies and thyroid dysfunction, that may present with similar symptoms, should be excluded. Both entities affect millions of women at reproductive age as the prevalence of PMS is given as 10-98% while PMDD affects 2-8%. Sex steroids and neurotransmitters have a central role in the etiology. The role of vitamins and minerals in the etiology and treatment of PMS and PMDD is open to discussion. Drugs that suppress ovarian sex steroid production, such as combined oral contraceptives or selective serotonin re-uptake inhibitors enhancing central serotonin delivery are used for treatment. Life-style changes and regular exercise also have a positive effect in milder cases. Tricyclic antidepressants and gonadotropin-releasing hormone analogues can be used in selected cases.
Greg J. Marchand, Ali Azadi, Katelyn Sainz, Ahmed Masoud, Sienna Anderson, Stacy Ruther, Kelly Ware, Sophia Hopewell, Giovanna Brazil, Alexa King, et al.
Journal of the Turkish-German Gynecological Association; https://doi.org/10.4274/jtgga.galenos.2019.2019.0185

, , , Fırat Ortaç, , Mete Güngör
Journal of the Turkish-German Gynecological Association, Volume 22, pp 53-57; https://doi.org/10.4274/jtgga.galenos.2020.2020.0107

Abstract:
Morcellation allows the removal of a large uterus and fibroids through small incisions with minimally invasive surgery. It helps to prevent the complications associated with large incisions in both hysterectomy and myomectomy operations. Currently, there is much debate regarding the use of power morcellation in laparoscopic hysterectomy and myomectomy, mainly due to the risk of peritoneal dissemination of undiagnosed uterine sarcomas. Unfortunately, there is no valid pre-operative diagnostic method that can differentiate sarcomas from myomas, and the currently available scientific literature regarding morcellation is insufficient. As the Turkish Society of Minimally Invasive Gynecological Oncology, we present our consensus opinion and suggestions for the preoperative evaluation and morcellation of fibroids, in line with the recent literature.
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