Publications by authors named "Cihan Comba"

19 Publications

  • Page 1 of 1

Vaginal cancer as a late complication of radiotherapy for endometrial cancer and ileo-perineal fistula after total pelvic exenteration.

J Gynecol Oncol 2021 Jul;32(4):e63

Department of Obstetrics and Gynecology, Karadeniz Technical University Hospital, Trabzon, Turkey.

Pelvic exenteration is a highly morbid operation and remains one of the most catastrophic surgical procedures in gynecological oncology. We would like to present the case of total pelvic exenteration for vaginal cancer after radiotherapy for endometrial cancer as a secondary cancer. A 62-year-old woman, whose gravida: 3, parity: 2, body mass index: 35.9 kg/m², presented with complaints of vaginal bleeding. She had undergone a surgery because of a stage IB grade 2 endometrioid-type adenocarcinoma seventeen years previously. Following the surgery, she had external pelvic radiotherapy and brachytherapy. A palpable, solid and ulcerative mass was detected extending from the vaginal cuff area to the vestibulum vagina on the left postero-lateral wall of the vagina. The 5-cm vaginal mass was seen at vaginal examination. A punch biopsy from a pathological examination of the tumoral lesion was reported as a squamous cell carcinoma. Pelvic exenteration was performed and ileo-perineal fistula occurred after six months this surgery. In conclusion, we considered that this malignancy was a secondary malignancy induced by radiotherapy.
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July 2021

Triangle of COVID, anxiety and menstrual cycle.

J Obstet Gynaecol 2021 May 6:1-5. Epub 2021 May 6.

Department of Gynecology and Obstetrics, Haseki Sultangazi Education and Research Hospital, Istanbul, Turkey.

This study aimed to examine whether the menstrual cycles of women with regular cycles have been affected by the COVID 19 pandemic. This cross-sectional online survey study evaluated the menstrual cycle characteristics of women in the reproductive phase of their lives during the COVID-19 pandemic in May 2020. Changes before and after COVID-19 were evaluated with a paired sample -test and chi-square test. A Pearson correlation test was used to show the relationships between variables. The study was completed with 263 participants in total. The average age of the participants was 26.3 ± 6.9 (18-45). Participants' duration of period ( = .003) and pads used per day ( = .002) decreased compared to their experience before the COVID-19 outbreak. The mean total MSQ score was 3.1 ± 0.8 (0-4), mean STAI-1 score was 45.1 ± 9 (20-78) and mean STAI-II score was 43.3 ± 5.9 (30-69). It was found that STAI-I and STAI-II scores showed a positive correlation with MSQ-Somatic subgroup scores( = 0.153,  = .013; 0.190,  = .002) and MSQ-Total scores (0.144,  = .020; 0.175,  = .004). With the COVID-19 pandemic, increased anxiety scores increased women's menstrual symptoms while the length of periods and the number of pads used decreased.Impact statement The COVID 19 pandemic, has caused enormous psychological distress potentially resulting in the development of posttraumatic stress disorder. The menstrual cycle is a process that can be affected by psychological stress. This is the first study to examine the relationship between stress caused by the COVID-19 pandemic and the menstrual cycle. The increases in the degree of anxiety and stress as a result of the COVID-19 outbreak was found to be high enough to affect the characteristics of the menstrual cycle in the women surveyed.? In a prospective study intended to be carried out after the outbreak ends in the future, it will be possible to evaluate whether the menstrual cycle parameters return to their former order and consequently this hypothesis will be able to be more definitively confirmed.
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May 2021

Comparison of Postoperative Benign Pelvic Cysts Occurred after Gynecologic or Gyne-oncologic Surgery Treated with Percutaneous Transcatheteric Sclerosant Alcohol Therapy.

Gynecol Minim Invasive Ther 2020 Oct-Dec;9(4):198-203. Epub 2020 Oct 15.

Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, Medipol Mega University Hospital, Istanbul, Turkey.

Objectives: Here, we compare the success of percutaneous transcatheter sclerosant alcohol therapy (PTSAT) for the postoperative treatment of benign pelvic cysts that occurred after gynecologic surgery.

Materials And Methods: The study is a retrospective case-control trial. Gynecological patients who had symptoms due to postoperative pelvic cysts and received PTSAT after gynecologic surgery, between October 2008 and January 2018, were examined in a single training and research hospital in Turkey. Some factors were investigated for associations with postoperative pelvic cyst formation in patients who underwent gynecologic operations for malignancies or benign conditions. Statistical analysis used: The association between two independent and nonnormally distributed continuous variables was analyzed with the Mann-Whitney U-test. Spearman's rho correlation analysis was conducted to determine the correlation of two nonnormally distributed variables. Chi-square (or Fisher's exact test, when more suitable) was used to examine the correlation between categorical variables.

Results: Statistically significant differences were found in terms of the average age was higher in patients with malignancies, and the average postoperative pelvic cyst detection time was higher in patients with benign pelvic cysts. While all patients were treated with PTSAT, repetitive PTSAT was required for seven benign and ten malign cases.

Conclusion: Patients with pelvic cysts that occurred after gynecologic surgery for malignant conditions, large volume pelvic cysts and patients with benign cysts who underwent more than one surgery required recurrent PTSAT.
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October 2020

Vulvar abscess as a late complication following the minimally-invasive Mini-Sling procedure for stress urinary incontinence.

Eur J Obstet Gynecol Reprod Biol 2021 Jan 3;256:514-515. Epub 2020 Nov 3.

Karadeniz Technical University Faculty of Medicine, Department of Obstetrics and Gynecology, Trabzon, Turkey.

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January 2021

Celiac disease does not influence markers of ovarian reserve in adolescent girls.

Arch Gynecol Obstet 2020 11 27;302(5):1263-1269. Epub 2020 Jun 27.

Department of Obstetrics and Gynecology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey.

Purpose: The aim of the study was to determine whether celiac disease affects ovarian reserve assessed by antral follicle counting, ovarian volume, and anti-müllerian hormone in adolescent patients.

Methods: This case-control multicenter trial was performed from January 1, 2017 to May 31, 2018 and included 45 girls. On days 2-5 of the menstrual cycle, measurements of serum follicle stimulating hormone, luteinizing hormone, estradiol, prolactin, and anti-müllerian hormone were performed. Antral follicle counts and ovarian volumes were determined on the same day.

Results: Evaluation was made of 21 (47.7%) celiac patients with a mean age of 15.8 ± 1.3 years, and 24 (52.3%) healthy control subjects with a mean age of 16.2 ± 1.2. There was no difference between the groups in respect of right and left ovarian volumes (p = 0.790 and p = 0.670, respectively). Serum levels of anti-müllerian hormone of the celiac patients and controls were found comparable [(3.7 ± 2.9 (0.5-12) and 3.6 ± 1.8 (1.2-8.1)] ng/mL, respectively, p = 0.915).

Conclusions: Celiac disease may not affect the ovarian reserve determined with established ovarian reserve markers including antral follicle counting, ovarian volume, and anti-müllerian hormone in adolescent patients.

Trial Registration: identifier (NCT number): NCT04024449
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November 2020

Comparison of pain and proper sample status according to usage of tenaculum and analgesia: a randomized clinical trial.

Obstet Gynecol Sci 2020 Jul 19;63(4):506-513. Epub 2020 Jun 19.

Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Medipol University Mega Hospital, Istanbul, Turkey.

Objective: Colposcopic biopsy is a discomfortable procedure. Additionally, it creates negative influence on sexuality. This study aimed to investigate the relationships among tenaculum, pain perception, and biopsy size during colposcopy.

Methods: In total, 228 patients who underwent colposcopy-directed biopsy were included, and randomized into 4 groups based on whether analgesic and tenaculum were used and replaced (tenaculum with n=58/without analgesic n=56, no tenaculum replacement with n=57/without analgesic n=57). Lidocaine hydrochloride (40 mg) plus adrenaline (0.025 mg) was administered in the analgesic groups. The pain was assessed using a linear visual analog scale. The biopsy specimen size was measured in millimeters.

Results: The mean age of the patients was 42.85±8.88 years. The most frequent colposcopy indications were atypical squamous cells of undetermined significance and human papilloma virus-positive results on cervical cytology (30.2%; n=69). Low- and high-grade intraepithelial lesions were noted in 14.91% (n=34) and 10.96% (n=25) women through colposcopy-directed biopsy results, respectively. Tenaculum replacement increased pain perception in the without analgesic group; however, no statistically significant differences were noted between of the groups with and without tenaculum replacement with analgesic. The size and number of biopsy specimens were not associated with tenaculum replacement and analgesic use.

Conclusion: Administration of analgesics decreased discomfort and pain in patients. Tenaculum replacement aided colposcopists in manipulating the cervix. Additionally, administration of analgesics relieved pain in the tenaculum replacement group.

Trial Registration: Identifier: NCT03279666.
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July 2020

Administration of rectal cytotec versus rectal buscopan before hysteroscopy.

Minim Invasive Ther Allied Technol 2020 Jun 3:1-5. Epub 2020 Jun 3.

Department of Gynecologic Oncology, Bakirkoy Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.

Our objective was to compare the effect of rectal misoprostol (Cytotec) versus rectal hyoscine-n-butyl bromide (Buscopan) on patients undergoing hysteroscopy. We hypothesised that HBB may have a role in cervical priming. This trial was conducted at Bezmialem Vakif University Hospital. Women of reproductive age between 18-50 years who were scheduled for operative hysteroscopy indicated by type 1 submucous myoma or endometrial polyps were recruited for the study. Ninety patients were divided randomly into three groups. Group 1 received placebo treatment. Group 2 received rectal 200 mcg misoprostol and Group 3 received rectal 20 mg hyoscine-n-butyl bromide two hours before the procedure. Procedures were performed using a bipolar 26 F (9 mm) continuous-flow rigid resectoscope with a 30° lens. The outcome measures included cervical dilation width and time, ease of cervical dilation, procedure time and operative complications. Postoperative self-rated pain was assessed one hour after the procedure. Thirteen patients (43. 3%) in the placebo treatment group, 11 patients (36.7%) in the misoprostol group and four patients (13.3%) in the hyoscine-n-butyl bromide group needed analgesics postoperatively ( = .02). The mean duration of cervical dilation time was longest in Group 1 and shortest in Group 3, however this difference did not reach statistical significance (=.11). There was no difference with regard to other studied parameters. HBB reduced the need for pain medication compared to placebo. Larger studies are needed to further investigate the role of HBB in facilitating pre-operative cervical priming.
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June 2020

The effects of exogenous oral micronized progesterone on first trimester aneuploidy screening markers in women with threatened miscarriage: a matched case control study.

J Matern Fetal Neonatal Med 2020 May 26:1-6. Epub 2020 May 26.

Department of Obstetrics and Gynecology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey.

To evaluate the effect of using progesterone due to early vaginal bleeding on aneuploidy screening markers in the first trimester. This case control study includes the pregnant women who applied to our clinic in order to have a screening test for Down syndrome in the weeks of 11°-136. The patients were divided into three groups. Self reported vaginal bleeding with progesterone therapy (Bl+, Prg+, n:70), Self reported vaginal bleeding without progesterone therapy (Bl+, Prg-, n:70) and as a control group pregnant women who had no vaginal bleeding. (NoBl, NoPrg, n:70). In all patients, free beta-human chorionic gonadotrophin (β-hCG), pregnancy associated plasma protein-A (PAPP-A) levels and nuchal translucency (NT) thickness were analyzed. Mean MoMs of the markers were compared between three groups. In the two groups with vaginal bleeding (Bl+, Prg + and Bl+, Prg-) the free β-Hcg MoM values were statistically higher (1.22 ± 0.72, 0.98 ± 0.45, respectively) compared to the No Bleeding/No Progesterone group (0.81 ± 0.52) ( ≤ 0.001,  ≤ .01, respectively). However, no significant difference was found between the free β-hCG MoM value of women with Bl+, Prg + group (1.22 ± 0.72) and Bl+, Prg - group (0.98 ± 0.45). (: .053, significance level limitation with Bonferroni correction : .017). PAPP-A and NT thickness did not differ significantly between the groups. Our data did not find an association between the use of oral progesterone and any alternations in first trimester screening parameters. Regardless of the progesterone usage, vaginal bleeding in the first trimester pregnancies increased the free β-hCG MoM values compared to pregnancies without vaginal bleeding during pregnancy.
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May 2020

The impact of concurrent HPV infections on the presentation of high grade cervical intraepithelial lesions.

Ginekol Pol 2020;91(6):324-330. Epub 2020 May 6.

Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Obstetrics and Gynecology, İstanbul, Turkey.

Objectives: We investigate how concurrent high-risk (hr) HPV (human papillomavirus) genotypes affect CIN2-3 risk and evaluate the relationship of different genotype combinations with cervical epithelial lesions.

Material And Methods: This study included HPV positive patients between the ages of 30 and 60 who underwent liquid-based cervical smears and HPV screening through community-based, cervical cancer screening programs between June 2015 and June 2017. The impact of the increase in hrHPV types was calculated by estimating how it changed the odds ratio of CIN2-3 risk.

Results: The rate of multiple concurrent HPV infections was 48.7% in the CIN2-3 group and 58.4% in the CIN1 group. Among patients in the CIN2-3 and CIN1 groups, the most common HPV coinfection was respectively HPV 16+31 and HPV 16+51. The HPV 51 ratio in CIN1 patients was 28.9% and the HPV 51 ratio in the CIN2-3 patient was 6.6%. With every increase in the number of hrHPV infection types, the frequency of CIN2-3 decreased [OR: 0.72, 95% CI: 0.54-0.95]. For all hrHPV combinations, the addition of HPV 16 was associated with a higher risk of CIN2-3.

Conclusions: An increase in number of hrHPV types is associated with lower CIN2-3 risk. Further cohort studies with larger samples are needed to clarify this relationship. The available evidence suggests that HPV 16 genotype plays an important role in patients with high-grade cervical lesions and has a negative impact on the cervix in concurrent multiple HPV infections.
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May 2020

Comparison of epidural and intravenous route for acute and chronic postoperative pain control in patients with gynecological malignancy.

Agri 2020 Apr;32(2):91-98

Department of Gynecologic Oncology, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey.

Objectives: This study compared the effects of patient-controlled epidural and intravenous analgesia on acute and chronic postoperative pain in patients who were operated on for gynecological malignancy.

Methods: Postoperatively, patient-controlled analgesia was administered via epidural route to Group 1 and the intravenous route to Group 2. Pain was evaluated using the Visual Analog Scale (VAS) in the acute phase at postoperative 24 hours and at 6 months in the chronic phase.

Results: The VAS scores at 24 hours were lower in Group 1 than in Group 2 (3.29 vs 3.93; p<0.05). The VAS scores at 6 months were 2.03 in Group 1 and 2.53 in Group 2, indicating no statistically significant difference (p>0.05). There was no significant difference in the Leeds Assessment of Neuropathic Symptoms and Signs pain scale scores at 6 months (p>0.05).

Conclusion: The results showed that epidural and intravenous analgesia had a similar effect regarding the chronicity of pain but better outcomes were achieved with epidural analgesia in the acute stage.
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April 2020

Comparison of laparoendoscopic single-site (LESS) surgery and conventional multiport laparoscopic (CMPL) surgery for hysterectomy: long-term outcomes of abdominal incisional scar.

J Obstet Gynaecol 2020 Feb 26;40(2):217-221. Epub 2019 Jul 26.

Department of Obstetrics and Gynecology, Oldenburg University, Oldenburg, Germany.

There is scarcity of data about the long-term results such as port-site hernia, body image scale and cosmesis scale outcomes between laparoendoscopic single-site (LESS) surgery and conventional multiport laparoscopy (CMPL) for hysterectomy. Eighty women, who underwent total hysterectomy by the LESS ( = 40) and CMPL ( = 40) technique due to benign and malign gynecological disorders, were evaluated with a cosmesis and body image questionnaire in an age-matched cohort study.Median follow-up time was 25 (6-30) months in both groups. The mean age of the patients was 49.3 ± 6.3 years. The mean body image scale scores were 5.3 ± 0.6 and 5.5 ± 1.2 in the LESS and CMPL groups, respectively ( = 0.268). The mean cosmesis and scar scale scores were significantly higher in the LESS group compared to the CMPL group ( = .011 and  < .001, respectively). Port-site hernia was detected in two patients in the LESS group, but not in the CMPL group. There was no cuff dehiscence in the LESS nor in the CMPL group. The LESS technique provides better cosmesis when compared with the CMPL technique. The body image perceptions in the two groups were similar. Women who wish to undergo the LESS surgery should be informed about the risk of incisional hernia.Impact statement Short-term results of LESS hysterectomy such as complication rates, additional port requirement, conversion to CMPL or laparotomy, pain score and analgesic use were evaluated in various studies. Several studies have been published on the safety and efficacy of single-port laparoscopic hysterectomy (LH); however, it has been unclear whether single-port LH offers benefits over multiport LH regarding long-term patient satisfaction and cosmetic satisfaction. In this prospective cohort study, we aimed to compare long-term results (at least six months) of abdominal incisional scar between LESS and CMPL surgery for hysterectomy. The LESS technique provides better cosmesis when compared with the CMPL technique, although, the body image perceptions in the two groups were similar. LESS technique can be offered as an option for hysterectomy since it provides better long-term cosmesis compared to CMPL.
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February 2020

Impact of pre-operative walking on post-operative bowel function in patients with gynecologic cancer.

Int J Gynecol Cancer 2019 10 19;29(8):1311-1316. Epub 2019 Jul 19.

Mugla Sitki Kocman Universitesi, Mugla, Turkey.

Background: There is a paucity of data on whether pre-operative walking and functional capacity has a direct association with post-operative gastrointestinal function in patients who have undergone surgery to treat gynecologic cancers.

Objective: To explore the relationship between pre-operative walking and post-operative recovery of bowel function.

Methods: This randomized trial was performed from January 1, 2018 to August 31, 2018. All patients had a diagnosis of endometrial or ovarian cancer and were scheduled for comprehensive staging. Group A served as the control group who did not walk regularly on the last night before surgery. Patients in group B walked for 30 min at an average speed of 3 km/h from 20.00 to 20.30 and 21.30. to 22.00 on the last night before surgery under the supervision of a nurse or doctor. The study was registered with (no: NCT03553121).

Results: A total of 85 patients were enrolled: 43 patients were assigned to the walking group and 42 to the control group. There were no significant differences in demographics between the groups. Median age was 57.3±8.5 in the control and 59.9±9.1 in the walking group. In addition, 28 patients had endometrial cancer and 14 had ovarian cancer in the control group. 33 patients and 10 patients in the walking group had endometrial and ovarian cancer, respectively. The mean time to first flatus was shorter in the walking group than in the control group (32.5±10.4 vs 40.6±16.9 hours, respectively; p=0.010). In addition, the time to first defecation was significantly shorter in the walking group (62.8±26.7 vs 91.4±51.8 hours; p=0.002). Patients who walked before surgery were less likely to have post-operative paralytic ileus (25.0% vs 60.7%; p=0.003). Walking before the operative period and laparoscopic surgery independently protected against the development of post-operative paralytic ileus.

Conclusion: Walking before surgery expedited time to bowel motility and ability to tolerate food. In addition, this method significantly decreased the risk of post-operative paralytic ileus.We consider that walking before surgery may be integrated into the pre-operative management of patients under going surgery for gynecologic cancers.

Clinical Trial Registration: record number: NCT03553121.
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October 2019

Does the 'equal management of equal risks' model cause overtreatment in patients with positive cervical cytology results for ASCUS/non-HPV16/18 oncogenic types?

Diagn Cytopathol 2019 Feb 16;47(2):105-109. Epub 2018 Nov 16.

Department of Obstetrics and Gynaecology, Bakirkoy Dr. Sadi Konuk Teaching and Research Hospital, Istanbul, Turkey.

Objectives: According to the American Society of Colposcopy and Cervical Pathology (ASCCP), cervical cytology patients who test positive for atypical squamous cells of undetermined significance (ASCUS) and the human papilloma virus (HPV) positive are recommended to undergo colposcopies. This study compared the colposcopic biopsy evaluation results of patients with positive cervical cytology results for ASCUS and HPV with regards to their HPV genotypes.

Methods: This study included 179 patients who underwent cervical cancer screening tests between June 2015 and June 2017 and whose results displayed positive cervical cervical cytology results for ASCUS and HPV. Cytological samples were classified using the Bethesda system in liquid-based specimens. The Hybrid Capture II system was used to define the HPV-DNA. Colposcopic diagnoses and biopsy results were compared in terms of the outcomes of the Pap test and HPV genotypes.

Results: There were 107 ASCUS/HPV16/18-positive patients. Of the HPV 16/18 positive patients; 28 (26.1%) patients were detected with CIN1, 8 (7.5%) patients were detected with CIN2, 6 (6%) patients were detected with CIN3, and 1 (0.9%) patient was detected with cervical cancer. Of the 72 non-HPV 16-18 positive patients; 8 (11%) patients were detected with CIN1 and 2 (2.7%) patients were detected with CIN2.

Conclusion: This study believes that the ASCCP recommendations, which state that a 'colposcopy should be performed on all women with positive cytology for ASCUS/non-HPV16/18 oncogenic types', is required to be revised. This will reduce the rate of the colposcopy procedures by 40% in women with ASCUS/HPV positivity.
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February 2019

Immediate biopsy of cervical cytology-negative and non-HPV-16/18 oncogenic types positive patients.

Diagn Cytopathol 2018 Apr 19;46(4):326-330. Epub 2018 Feb 19.

Bakırköy Dr. Sadi Konuk Education and Reseach Hospital Obstetrics and Gynecology, İstanbul TR 34147, Turkey.

Background: According to the American Society of Colposcopy and Cervical Pathology (ASCCP), a co-test is recommended for patients one year after the detection of non-HPV 16/18 viral types in association with a negative cervical cytology. In this study, we used immediate colposcopy to evaluate the risks to the patient during the one year waiting period.

Methods: We included 544 Hpv-positive/cervical cytology-negative patients who underwent cervical cancer screening from June 2015 to June 2017. Cytological specimens were classified using the Bethesta method on a liquid based preparation. We used the Hybrid Capture 2 system to define HPV DNA. Biopsies were performed on all patients under colposcopy.

Results: Three hundred and seventy-five patients had HPV types 16/18 and 169 had non-HPV-16/18 oncogenic types. Of the 169 patients who had non-HPV-16/18 oncogenic types, 151 (89%) had no dysplasia, 16 (9.4%) had CIN 1, and 2 (1.1%) had CIN 2/CIN 3.

Conclusion: For the patients who had cervical cytology negative/non-HPV-16/18 positive, we detected that 1.1% of these women had CIN 2-3. For this reason, by chasing the algorithm recommended by guidelines, gynecologists take risk missing a diagnosis of CIN 2 plus lesion in 1.1% of patients.
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April 2018

Laparoendoscopic Single-Site Sentinel Lymph Node Detection in Endometrial Cancer.

J Minim Invasive Gynecol 2018 Jul - Aug;25(5):776. Epub 2017 Nov 13.

Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Bakırköy Dr. Sadi Konuk Education and Research Hospital, Health Sciences University, İstanbul, Turkey.

Study Objective: To demonstrate the feasibility of sentinel lymph node (SLN) biopsy using a laparoendoscopic single-site (LESS) approach in endometrial cancer (EC).

Design: A step-by-step video demonstration of the surgical procedure (Canadian Task Force Classification III).

Setting: The satisfaction of patients who undergo LESS hysterectomy is greater than that reported by patients who undergo multiport laparoscopic hysterectomy, owing to better cosmesis and reduced postoperative analgesic requirements [1]. SLN biopsy is associated with significantly lower estimated blood loss, shorter operation time, and less morbidity compared with systematic lymphadenectomy [2]. LESS surgery can be more feasible and safer with the use of SLN biopsy compared with complete lymphadenectomy in patients with early-stage EC.

Interventions: This 69-year-old woman with grade 2 endometrioid EC underwent SLN mapping followed by LESS SLN biopsy, total hysterectomy, and bilateral salpingo-oophorectomy. Before the umbilical incision was made, 1.25 mg/mL of indocyanine green was injected into the cervical stroma at the 3 o'clock and 9 o'clock positions to both deep and superficial levels. A 10-mm 30° standard-length optical camera for near-infrared fluorescence imaging was used. The total operative time was 75 minutes, and the estimated blood loss was 20 mL. SLNs were detected bilaterally between proximal parts of the external iliac arteries and veins. After SLN resection, total hysterectomy and bilateral salpingo-oophorectomy were performed. No postoperative complications occurred. The patient was discharged at 30 hours after surgery. In the final pathology, stage 1A G2 EC was detected.

Conclusion: LESS SLN biopsy and TLH-BSO is a feasible procedure and sentinel lymph node concept may increase the use of LESS in EC.
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August 2019

Role of inflammatory mediators in patients with recurrent pregnancy loss.

Fertil Steril 2015 Dec 11;104(6):1467-74.e1. Epub 2015 Sep 11.

Department of Obstetrics and Gynecology, Istanbul University School of Medicine, Istanbul, Turkey.

Objective: To examine interleukin-12 (IL-12), IL-18, IFN-γ, intracellular adhesion molecule-1 (ICAM-1), leukemia inhibitory factor (LIF), and migration inhibitory factor (MIF) levels in precisely-timed blood and endometrial tissue samples from women with idiopathic recurrent pregnancy loss (RPL).

Design: Case-control study.

Setting: University hospital.

Patient(s): Twenty-one women with RPL and 20 women with proven fertility (controls).

Intervention(s): Primary endometrial cells and blood samples during the midsecretory phase (days 19-23).

Main Outcome Measure(s): Detection of IL-12, IL-18, IFN-γ, ICAM-1, LIF, and MIF via enzyme-linked immunosorbent assay in both blood and endometrial tissue samples.

Result(s): The blood and tissue levels of IL-12, IL-18, and IFN-γ were statistically significantly higher, and the blood and tissue levels of LIF and MIF were statistically significantly lower in patients with RPL. Only the level of tissue ICAM-1 was higher in patients with RPL. There was a strong correlation between blood and tissue level measurements of IL-12, IL-18, LIF, and MIF.

Conclusion(s): Our findings support the hypothesis that inflammatory processes may contribute to pregnancy loss, possibly through their role in implantation. We found that blood and tissue levels of IL-18, LIF, and MIF, and tissue levels of IL-12, IFN-γ, and ICAM-1 have statistically significant prognostic relevance.
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December 2015

Changes in Markers of Ovarian Reserve After Laparoscopic Ovarian Cystectomy.

J Minim Invasive Gynecol 2015 Sep-Oct;22(6):997-1003. Epub 2015 May 8.

Department of Obstetrics, Gynecology and Reproductive Sciences, Gulhane Military Medical Academy, Ankara, Turkey. Electronic address:

Study Objective: This study was conducted to determine the changes in ovarian reserve markers after laparoscopic ovarian cystectomy (LOC).

Design: Prospective cohort study (Canadian Task Force classification II-2).

Setting: University teaching hospital.

Patients: Fifty 50 patients who underwent LOC were prospectively examined to determine the changes in serum markers of ovarian reserve, starting from 1 month before and 3 months after consecutive operations.

Interventions: Changes in serum markers were compared between the following groups: endometrioma cysts (n = 26) versus nonendometrioma cysts (n = 24), unilateral cystectomy (n = 38) versus bilateral cystectomy (n = 12), and bilateral endometrioma extirpation (n = 10) versus other cystectomy operations (n = 40).

Measurements And Main Results: A significant change was noticed between the preoperative and postoperative antimüllerian hormone (AMH) levels (2.67 ± 2.67 ng/mL vs 1.84 ± 1.72 ng/mL, p < .0001). Serum AMH levels were found to be significantly decreased in endometrioma (p = .002), nonendometrioma (p = .019), unilateral cystectomy (p = .001), bilateral cystectomy (p = .005), bilateral endometrioma (p = .011), and cysts other than bilateral endometrioma (p = .000) groups.

Conclusion: The ovarian reserve was found to be diminished after LOC regardless of the presence of endometrioma that could be distinguishable by serum AMH levels.
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April 2016

Extrapulmonary lymphangioleiomyomatosis mimicking lymphoma metastatic to uterus.

J Obstet Gynaecol Res 2015 May 10;41(5):823-7. Epub 2014 Dec 10.

Department of Obstetrics and Gynaecology, Faculty of Medicine, Istanbul University, Istanbul, Turkey.

Lymphangioleiomyomatosis is a very rare disease that primarily affects the lungs. The atypical smooth muscle cells in these tumors stain both with smooth muscle markers and melanocytic markers characteristically like their counterparts in other members of the PEComa family. Extrapulmonary lymphangioleiomyomatosis, especially without pulmonary involvement, is extremely rare. The clinical importance of lymphangioleiomyomatosis lies in the fact that it may mimic other malignant diseases, such as lymphoma or sarcoma. Here, we report a case of extrapulmonary lymphangioleiomyomatosis without involvement of the lungs, in a patient pre-diagnosed as having lymphoma metastasized to the uterus or uterine sarcoma.
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May 2015

Persistent ascites resolving with gonadotropin-releasing-hormone-agonist 18 months after hospitalization for severe ovarian hyperstimulation syndrome.

Arch Gynecol Obstet 2014 Jan 12;289(1):223-5. Epub 2013 Jul 12.

Kadin Hastaliklari ve Dogum Anabilim Dalı, Istanbul Universitesi Istanbul Tip Fakultesi, Capa Findikzade, 34093, Istanbul, Turkey,

Ovarian hyperstimulation syndrome (OHSS) is a life- threatening complication of controlled ovarian stimulation. One of the main symptoms of OHSS is ascites. Treatment is symptomatic with resolution of the symptoms over days to weeks. We report a case of severe OHSS with persistent ascites 18 months after the diagnosis. Persistent ascites secondary to OHSS was diagnosed and single dose leuprolide acetate depot 11.25 mg was administered. At follow-up, no ascites was observed.
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January 2014