Mini-Laparoscopic Gynecological Surgery Using Smaller Ports Minimizes Incisional Pain and Postoperative Scar Size: A Paired Sample Analysis.

Objective. The aim of this study was to assess postoperative incisional pain and cosmetic scores in mini-laparoscopic gynecological surgeries undertaken with different port sizes. Material and Method. In this prospective study, all women who underwent mini-laparoscopic gynecological surgery with 2.4-, 3-, and 5-mm lateral ports for benign gynecological conditions between March 2017 and April 2019 were included. The primary outcome was postoperative incisional pain at rest, walking, and after a provoked Valsalva maneuver assessed by numeric rating scale scores at 6 hours, 12 hours, 24 hours, and 3 days and 7 days after surgery. Secondary outcome measures included cosmetic scores of each port site (evaluated by using patient-observer scar assessment scale [POSAS]), operation time, and intra- and postoperative complications. Results. A total of 330 lateral port sites in 110 patients who underwent benign gynecological surgery via mini-laparoscopy were assessed for pain and cosmetic appearance. Pain scores at each time point were significantly lower for 2.4- and 3-mm ports than those for 5-mm ports; however, no significant difference was detected between 2.4-mm and 3-mm port sites (P = .6). The difference was more evident at 24 hours when routine analgesic drugs were stopped (P = .004). For POSAS scores, both 2.4-mm and 3-mm ports were superior to 5-mm port sites (P = .002); however, there was no significant difference between 2.4-mm and 3-mm port sites (P = .2). There were 2 port-related complications: one subcutaneous emphysema and one bleeding from a 5-mm trocar site 1 hour after surgery. Conclusion. Mini-laparoscopic gynecologic surgery using smaller ports resulted in decreased postoperative incisional pain and superior cosmetic appearance.

Endometrial volume measured on the day of embryo transfer is not associated with live birth rates in IVF: A prospective study and review of the literature.

OBJECTIVE: To evaluate the effect of endometrial volume (EV) on the live birth rates (LBR)s in fresh or frozen embryo transfer (ET) cycles. MATERIAL AND METHODS: This is a prospective study including all women who underwent a fresh or frozen single blastocyst transfer between January 2017 and September 2018 in a university affiliated private hospital. Patients with advanced age (>42years), congenital uterine anomalies, endometrial or myometrial abnormalities, those with a difficult ET, those with only poor-quality blastocysts available for transfer, those in whom an optimal 3D TVUS image could not be obtained and those who were lost to follow-up were excluded. Endometrial volume was assessed using Virtual Organ Computer Aided Analysis program immediately prior to ET by two different observers using a standardized technique. The association of ET outcome and EV was evaluated by receiver operating characteristics (ROC) curve and logistic regression analysis. RESULTS: A total of 142 patients were included in the final analysis. Patients were grouped according the EV percentiles (p); 5thp (1.7 mL), 10thp (2.2 mL), 25thp (2.9 mL), 50thp (4.3 mL) and >75thp (>5.3 mL) groups. ROC curve analysis was not predictive of LBRs, with an AUC (95 % CI) = 0.48 (0.38-0.58). There was no critical threshold, below which pregnancy was unlikely to occur. No significant association was observed between EV and any of the evaluated clinical outcomes. CONCLUSION(S): When controlled for potential confounders, EV assessed by 3D TVUS is not a useful tool for predicting pregnancy in single blastocyst ET cycles.

Platelet-rich plasma another add-on treatment getting out of hand? How can clinicians preserve the best interest of their patients?

Add-on treatments in IVF are utilized to a great extent but without sufficient evidence showing their effectiveness. Since the offered treatments are usually costly and may be associated with yet unknown risks, this practice is not in the best interest of couples that may go to great lengths to conceive and have an offspring carrying their own genetic make-up. A recent addition to this armamentarium is the administration of platelet-rich plasma (PRP) in women with diminished ovarian reserve, implantation failures, and a thin endometrium. The only evidence for PRP comes from small scale and mostly before and after studies with clinically irrelevant end points. PRP has not been subjected to a rigorous clinical trial. It is a typical example of an add-on gaining widespread popularity based on biological plausibility and mind-bending theoretical presumptions. We should be extremely cautious prior to implementing PRP on a widescale and await the results of well-designed studies.

Awareness of fertility and reproductive aging in women seeking oocyte cryopreservation, reproductive aged controls, and female health care professionals: A comparative study.

OBJECTIVE: To compare the awareness of fertility and reproductive aging in women seeking oocyte cryopreservation (OC) with age matched controls. STUDY DESIGN: In this cross-sectional comparative study, women who were candidates for OC due to impending oocyte depletion (n = 81) were compared to age matched reproductive aged women (RAW) (n = 91) and female healthcare professionals (FHP) (n = 82) in terms of awareness about fertility and reproductive aging and knowledge about OC. A study specific 18-item questionnaire was constructed on the basis of previous research on OC and fertility. RESULTS: Awareness of fertility and reproductive aging was similar among groups. The majority of study population was quite realistic of women's most fertile age period whereas they were fairly optimistic about the age that a woman may lose her ability to conceive, monthly fecundity rate, and estimated in vitro fertilization treatment success. OC candidates and FHP were more realistic compared to RAW regarding the age after which the chances of conception is severely diminished (p = 0.005). When the knowledge on OC and willingness to preserve fertility in the future were asked to FHP and RAW, 90% stated that they were aware of the option (93% in FHP versus 88% in RAW, p = 0.006). However, they lacked detailed information about OC and they were unlikely to consider it in the future. CONCLUSIONS: Women seeking OC did not appear to have a better awareness of reproductive ageing compared to the general female population. The results of this study highlight the need for additional awareness campaigns and education on both personal and professional levels.

Clermont-Ferrand versus Vectec uterine manipulator for total laparoscopic hysterectomy.

OBJECTIVE: To compare the operation time and performance of two uterine manipulators used for total laparoscopic hysterectomy (TLH). MATERIAL AND METHODS: Design: Retrospective cohort analysis. Design classification: Canadian Task Force Classification II-2. SETTING: Tertiary-care university-based teaching hospital and academic affiliated private hospital. PATIENTS: All consecutive patients who underwent for TLH between January 2014 and June 2017. All operations were performed by two expert endoscopic surgeons using one of the following uterine manipulators depending on surgeon preferences: Clermont-Ferrand (CF) or Vectec (VT) MAUT60. Patients were excluded if additional surgeries such as urogynecological procedures were performed, TLH was converted to laparotomy prior to colpotomy, and when their operation records could not be obtained. A total of 169 patients were added to final analysis. Operation time, colpotomy time and the subjective performance of manipulators such as movement of the uterus, visualization of the vaginal fornices, and maintenance of pneumoperitoneum were evaluated by watching un-edited operation videos. RESULTS: A total of 169 patients (83 patients in CF group; 86 patients in VT group) were included in the final analysis. Patients' baseline characteristics were comparable between groups. Operation time and time required for colpotomy were significantly shorter in the VT group. Lateral movements of the manipulators and elevation of the uterus were better with VT compared to CF (p = .001 for both). Compared to the CF, VT was superior for visualization of the vaginal fornices (p = .004) and maintenance of pneumoperitoneum (p < .001). Both surgeons had perfect agreement on the performance grading of manipulators (p < .001, Kappa values were between 0.86-0.92). There was no difference between groups in estimated blood loss and duration of hospital stay. Reinsertion or the need to change the manipulator was not required in either group. No pelvic or vaginal abscess, cuff cellulitis, dehiscence, or hematoma formations were noted. CONCLUSION: Laparoscopic hysterectomy assisted with the VT uterine manipulator is associated with shorter operation and colpotomy time. Furthermore, the movements of uterus, visualization of the vaginal fornices, and maintenance of pneumoperitoneum were significantly better with VT compared to the CF manipulator.

Contained Power Morcellation Versus Transvaginal Extraction for Retrieval of Laparoscopically Removed Myomas: A Comparison of Perioperative Outcomes.

OBJECTIVE: To evaluate clinical and operative outcomes of transvaginal extraction (TVE) and contained power morcellation (CPM) for myoma retrieval after laparoscopic myomectomy. MATERIALS AND METHODS: Prospective data from 35 consecutive cases using CPM were compared with retrospective data of all cases using TVE from December 2014 to January 2017. Patients were matched 1:1 based on myoma diameter. A total of 62 women were included in the final analysis. Specimen retrieval was performed using the TVE or CPM within an insufflated isolation bag. RESULTS: Age, body mass index, mode of prior obstetric delivery, history of previous abdominal surgery, indication for myomectomy, and the myoma(s) characteristics were similar between groups. Retrieval time was significantly shorter in the TVE group compared with the CPM group: 10 minutes (3-15 minutes) versus 17 minutes (14-42 minutes); P < .001. Time required for placement of the instruments was 9.7 minutes for the isolation bag and 0.5 minutes for the vaginal extractor. Additional analgesic administration for pain relief was necessary in 13 patients (42%) in the TVE group and 23 patients (72%) in the CPM group ( P = .01). Total cost of the hospital stay was significantly higher in the CPM group compared with the TVE group ( P < .001). Estimated blood loss and duration of hospital stay were similar between groups. CONCLUSION: Both CPM and TVE can be used for safe retrieval of large myomas that are removed laparoscopically. Compared with CPM, TVE was associated with a shorter retrieval time, less postoperative pain, and less hospital costs.

Surgical correction of T-shaped uteri in women with reproductive failure: Long term anatomical and reproductive outcomes.

OBJECTIVE: To evaluate the long term anatomical and reproductive outcomes of hysteroscopic treatment for T shaped uterus in patients presenting with reproductive failure. METHODS: This prospective cohort study included 56 patients with a history of long-standing unexplained infertility, recurrent implantation failure (RIF), and/or recurrent pregnancy loss (RPL) who were eligible for metroplasty by office hysteroscopy. Office hysteroscopy under conscious sedation was performed. Anatomical outcomes were assessed with pre- and postoperative measurements of the transostial, isthmic and myometrial diameters and the uterine volume using three-dimensional transvaginal sonography (3D-TVS). Reproductive outcome was assessed after spontaneous or assisted conception. RESULTS: Hysteroscopic treatment significantly increased the volume of the uterus from a mean of 2.5+1mL before surgery to 3.2±1mL by the end of 1 year as measured by 3D-TVS. According to the main indication to perform metroplasty, 20 of 32 (62.5%) patients with long standing unexplained infertility, 9 of 14 (64%) patients with RIF, and 8 of 10 (80%) patients with RPL conceived either spontaneously or with assisted reproduction. CONCLUSIONS: Office hysteroscopic metroplasty results in a significant long-term expansion of the uterine cavity and improved reproductive outcomes in women presenting with a T shaped uterus and poor reproductive history.

Unidirectional barbed suture for vaginal cuff closure without backward stitch in total laparoscopic hysterectomy.

AIM: To evaluate the safety and efficacy of unidirectional barbed suture technique for vaginal cuff closure in total laparoscopic hysterectomy (TLH). METHODS: In a retrospective chart review, data were analyzed from 165 patients who underwent a TLH with an unidirectional barbed suture technique for vaginal cuff closure from January 2012 to June 2016 at tertiary-care university-based teaching hospital and academic affiliated hospital. Vaginal cuff was closed by single layer 3/0 V-Loc unidirectional 9″, 180 day Absorbable Wound Closure Device (Covidien Healthcare, Mansfield, MA) and the suture was not stitched backward to secure distal end. RESULTS: A total of 165 patients were included and the median age was 50 years (range, 35-84 years). The median completion time for hysterectomy time was 100 min (range, 40-240 min) and the median vaginal cuff closure time was 7 min (range, 4-15 min). The median estimated blood loss was 87.8 mL (range 30-250 mL) and the median uterine weight was 200 g (range, 40-900 g). Intraoperative complication included bladder perforation (1.2%) and postoperative complications were vaginal cuff dehiscence (1.8%), cuff cellulitis (0.6%), vesicovaginal fistula (0.6%) and unexplained fever (0.6%). CONCLUSION: According to the results of current study, the use of unidirectional barbed suture without backward stitching appears to be safe for the vaginal cuff closure in TLH.

Intraoperative endoscopic ultrasound guidance for laparoscopic excision of invisible symptomatic deep intramural myomas.

The aim of this study was to evaluate the feasibility of intraoperative endoscopic ultrasound guidance for excision of symptomatic deep intramural myomas that are not otherwise visible at laparoscopy. Seventeen patients with symptomatic deep intramural myomas who underwent laparoscopic myomectomy with intraoperative endoscopic ultrasound guidance were followed up and reported. All myomas were removed successfully. The endometrium was breached in one patient. All patients were relieved of their symptoms and three patients presenting with infertility conceived. There were no short- or long-term complications associated with the procedure. One patient who had multiple myomas necessitated intravenous iron treatment prior to discharge. Laparoscopic removal of small symptomatic deep intramural myomas is facilitated by the use of intraoperative endoscopic ultrasound that enables exact localisation and correct placement of the serosal incision. Impact statement What is already known on this subject: When the myoma is symptomatic, compressing the endometrium, does not show serosal protrusion and is not amenable to hysteroscopic resection, laparoscopic surgery may become challenging. What do the results of this study add: The use of intraoperative endoscopic ultrasound under these circumstances may facilitate the procedure by accurate identification of the myoma and correct placement of the serosal incision. What are the implications of these findings for clinical practice and/or further research: Intraoperative ultrasound should be more oftenly used to accurately locate deep intramural myomas to the end of making laparoscopy feasible and possibly decreasing recurrence by facilitating removal of otherwise unidentifiable disease.

Utilization of the Bologna criteria: a promise unfulfilled? A review of published and unpublished/ongoing trials.

OBJECTIVE: To study the use of the Bologna criteria (BC) for the definition of poor ovarian responders (POR) in clinical practice and research. DESIGN: Systematic review of published and unpublished/ongoing trials between January 2012 and August 2017 on POR. SETTING: Not applicable. PATIENT(S): Not applicable. INTERVENTION(S): The databases were searched using the relevant medical subject headings including all subheadings. The search was limited to humans and English language. The references of the included studies were cross-searched for possibly missed articles. Only clinical trials providing an evidence level ≥ III were included. Case reports, review, letters, and hypothetical articles were excluded. MAIN OUTCOME MEASURE(S): Extracted studies were divided into two groups: studies in which the BC were used or not. RESULT(S): One hundred nine published clinical studies analyzing a total of 30,540 women and 112 unpublished/ongoing trials were identified. The BC were used to define POR in 56 (51%) of the published and 44 (39%) of the unpublished trials. The use of the BC gradually increased from 29% to 53% from 2012 to 2017. Asian researchers were more likely to use the BC compared with European and North American researchers (65%, 49%, and 23%, respectively). Neither the design of the study nor the impact factor of the publishing journal was correlated with the use of the BC. CONCLUSION(S): There is still reluctance to use the BC for the definition of POR, which makes it difficult to combine data from small studies and reach a meaningful conclusion.

Laparoscopic repair of ureter damaged during laparoscopic hysterectomy: Presentation of two cases.

Ureter injuries are uncommon but dreaded complications in gynecologic surgery and a frequent cause of conversion to laparotomy. Recently, a few papers reported the repair of gynecologic ureteral injuries using laparoscopy with encouraging results. In these case reports, we aimed to present two laparoscopically repaired ureter injuries during total laparoscopic hysterectomies (TLH). In the first case, the ureter was transected during the dissection of the cardinal ligament, approximately 7 to 8 cm distal to the ureterovesical junction (UVJ), and in the second case, it was damaged approximately 10 cm distal to the UVJ. Both transections were identified during surgery. The injured ureter was repaired without converting to laparotomy or additional trocar insertion. Ureteroureterostomy was performed in both cases uneventfully. Although ureteric injury is a rare complication during TLH, it can be managed by the same surgeon laparoscopically during the same procedure.

Comparison of the effectiveness of topical silicone gel and corticosteroid cream on the pfannenstiel scar prevention - a randomized controlled trial.

OBJECTIVES: To compare the effects of topical silicone gel and corticosteroid cream for preventing hypertrophic scar and keloid formation following Pfannenstiel incisions. MATERIAL AND METHODS: Fifty patients operated for benign gynecological diseases through primary Pfannenstiel incision were included. The wounds were randomly allocated to the treatment and control arms. In the treatment arm, the wounds were divided into two halves; one was treated with silicone gel and the other with methylprednisolone cream. No treat-ment was administered to the control group. Scars using the modified Vancouver Scar Scale (MVSS), patient satisfaction, and side effects were evaluated before and after (3rd month when treatment discontinued and 6th month) the treatment. RESULTS: Thirty-nine patients (21 patients in the treatment group and 18 patients in the control group) completed the stu-dy. Intragroup comparisons of the 3rd month and 6th month scores of the MVSS revealed that the scores of all parameters (height, pigmentation, vascularity, pliability, and total MVSS score) significantly decreased at the 6th month evaluation as compared with the 3rd month evaluation in all groups (control, silicone, and methylprednisolone groups). Multiple group comparisons at the 6th month revealed that the most prominent improvements occurred in the methylprednisolone group in all MVSS parameters as compared with the control group and in the height, vascularity, and pigmentation parameters as compared with the silicone group. No side effects were experienced by the patients with either treatment and patient satisfaction was higher in the methylprednisolone group. CONCLUSION: The use of topical methylprednisolone cream in fresh wounds at the postoperative early period appears to be promising.

Could the female-to-male transgender population be donor candidates for uterus transplantation?

OBJECTIVE: To evaluate the eligibility of female-to-male (FtM) transgender people as donor candidates with regard to histologic, surgical, and social aspects. MATERIALS AND METHODS: In this prospective cohort study, 31 FtM transgender people underwent standard hysterectomy and bilateral salpingo-oophorectomy for gender reassignment upon their request. The pelvic viscera of the transgender people was intraoperatively observed and the histology of the removed uteri were evaluated for fertility capacity and procurement surgery. A questionnaire was administered to explore their attitude towards uterus donation. RESULTS: The mean ± standard deviation age was 28.5±5 years. The median duration of testosterone supplementation was 2.4 years; therefore, they all had irregular menstrual periods during this therapy. None had any previous abdominal surgery or additional morbidity. The mean uterine volume was 138±48 cm3. No adenomyosis, endometriosis, polyps, adhesions or uterine anomalies were either observed or reported. Endometrial histology was reported as proliferative (58%), atrophic (29%), and secretory (13%) pattern. Of the 31 transgender people, 30 (96.7%) had a positive attitude; only one had no opinion at the beginning. After detailed information about the procedure was given, 26 (84%) still wanted to volunteer for donation, but 4 (12%) changed their opinion to negative (p=0.12, McNemar test). CONCLUSION: The proposal of the FtM transgender population as uterus donor is a hypothetical model that has not been experienced before. Nevertheless, our experience revealed that the FtM transgender population would be good candidates socially, legally, and biologically.

The efficacy of laparoscopic presacral neurectomy in dysmenorrhea: is it related to the amount of excised neural tissue?

OBJECTIVE: To assess the correlation between the number of excised neural fibers and degree of pain relief following laparoscopic presacral neurectomy (LPSN). MATERIALS AND METHODS: In this before and after study, 20 patients with severe midline dysmenorrhea [Visual Analogue Scale (VAS) >80 mm] unresponsive to medical therapy were consecutively enrolled. All patients underwent LPSN. The superior hypogastric plexus was excised and sent for histologic confirmation. Two pathologists counted the number of neural fibers in the surgically removed tissue. VAS was used for pain assessment before and 2nd, 3rd, 6th, and 12th months after the operations. RESULTS: Out of the initial 20 patients undergoing LPSN, eight were excluded from the final analysis due to intraoperative diagnosis of endometriosis; therefore, the remaining 12 patients were evaluated. The pain scores significantly decreased at each follow-up visit compared with the preoperative period (p=0.002). The pathologists, who were blinded, reported the median (minimum-maximum) neural fiber count as 46 (20-85) and 47 (18-83). No significant correlation was demonstrated between the number of excised neural fibers and the amount of pain relief following LPSN. CONCLUSION: LPSN is an effective surgical procedure to control primary dysmenorrhea. Our preliminary results revealed that the degree of pain relief in cases of severe midline dysmenorrhea was not related to the amount of excised neural tissue in LPSN.

Is progestogen supplementation necessary to prevent abortion?

A prospective study was conducted to evaluate the effect of progestogens on the pregnancy outcome of threatened abortion (TA). A total of 251 pregnant women less than 20 weeks of gestational age (GA) were included. Group 1 consisted of women with vaginal bleeding who had already been under treatment with progestogens and Group 2 was composed of women with vaginal bleeding who were only followed without progestogen therapy, whereas Group 3 was the control group without any vaginal bleeding or progestogen therapy. The pregnancy outcomes and serum progesterone levels were compared among the groups. The mean serum progesterone concentrations were statistically significantly higher in Group 1 in comparison to Group 2 and 3 (p < 0.001). Abortion rates were similar among the study groups. Although progestogen supplementation leads to increased level of serum progesterone, this finding does not translate to its beneficial effect on the pregnancy outcomes in cases of TAs.

Cesarean Scar Pregnancy Managed with Conservative Treatment.

Cesarean scar pregnancy (CSP) is a rare, but life-threatening type of ectopic pregnancy. An exact and early diagnosis of CSP is very important for prognosis. The aim of the present study was to describe 4 women with CSP and discuss their clinical presentations, diagnoses, and various management options along with the published literature. Four women with a suspicion of CSP or cervical pregnancy were referred to our hospital between August 2013 and January 2014. All the patients were counseled about medical management options. After the treatment, serum beta human chorionic gonadotropin (ß-hCG) levels were followed weekly until they reached <5 mIU/mL. All the patients were diagnosed at the first trimester, with the average gestational age of 6.4±0.9 weeks. Treatment was systemic methotrexate (MTX) treatment in 3 of the 4 women, requiring no further intervention. The remaining 1 woman was treated with an intragestational administration of MTX. The mean time passed until ß-hCG reached <5 mIU/mL was 10.2±2.9 (range, 8-14) weeks, and the mean time passed until the gestational sac resolved was 21.5±3.5 (range, 18-25) weeks. Based on this limited number of case-series experience, it seems that CSP should be treated conservatively even if there are visible fetal cardiac activity, fetal poles, large gestational sacs, and high initial ß-hCG levels. Although the complete remission of the lesion takes a relatively long time, medical management via a noninvasive approach and follow-up should be tried as the first choice of therapy.

Microdose Flare-up Gonadotropin-releasing Hormone (GnRH) Agonist Versus GnRH Antagonist Protocols in Poor Ovarian Responders Undergoing Intracytoplasmic Sperm Injection.

BACKGROUND: Microdose flare-up GnRH agonist and GnRH antagonist have become more popular in the management of poor ovarian responders (POR) in recent years; however, the optimal protocol for POR patients undergoing in vitro fertilization has still been a challenge. METHODS: In this observational study design, two hundred forty four poor ovarian responders were retrospectively evaluated for their response to GnRH agonist protocol (group-1, n=135) or GnRH antagonist protocol (group-2, n=109). Clinical pregnancy rate was the primary end point and was compared between the groups. Student t-test, Mann Whitney U test and χ (2)-test were used to compare the groups. The p<0.05 was considered to show a statistically significant result. RESULTS: The mean total gonadotropin doses were 3814±891 IU in group 1 and 3539±877 IU in group 2 (p=0.02). The number of metaphase-II oocytes (3.6±2.4 vs. 2.8±1.9, p=0.005) and implantation rates (27.8% vs. 18.8%, p=0.04) in group 1 and group 2, respectively were significantly different. The fertilization rate in group 1 and group 2 was 73% vs. 68%, respectively (p=0.5) and clinical pregnancy rate was 19.8% vs. 14.4%, respectively (p=0.13). CONCLUSION: The GnRH agonist microdose flare-up protocol has favorable outcomes with respect to the number of oocytes retrieved and implantation rate; nevertheless, the clinical pregnancy rate was found to be similar in comparison to GnRH antagonist protocol in poor ovarian responders. GnRH antagonist protocol appears to be promising with significantly lower gonadotropin requirement and lower treatment cost in poor ovarian responders.

Robotic Versus Laparoscopic Radical Trachelectomy for Early-Stage Cervical Cancer: Case Report and Review of Literature.

We conducted a literature review to evaluate the minimally invasive fertility-sparing procedures, namely robotic radical trachelectomy (RRT) and laparoscopic radical trachelectomy (LRT), in patients with early-stage cervical cancer. We searched PubMed, MEDLINE, Ovid, Google Scholar, and Scopus up to July 2015 using the following key words and their combinations: cervical cancer, early stage, fertility-sparing surgery, radical trachelectomy, robotic trachelectomy, and laparoscopic trachelectomy. Papers providing details of RRT and LRT separately were included. Extracted papers and their bibliographies were reviewed according to the purpose of the study, and demographic, surgical, and clinical parameters were analyzed. Our review comprised 45 cases of RRT and 216 cases (including our case) of LRT. The median (range) patient age was 29 (9) years in the RRT group and 32 (10) years in the LRT group (p < .001). Histological types and stages were significantly different in the 2 groups (p < .001 for both). The median length of excised parametrial tissue was significantly higher in the RRT group (p < .001). The hysterectomy conversion rate on the results of frozen section examination was significantly higher in the RRT group (37% vs 6.5%; p < .001). There was a significant difference in median lymph node count based on the surgical approach (RRT: 22 [range, 21] vs LRT: 32 [range, 14]; p = .02). Estimated blood loss and length of hospital stay were significantly higher in the LRT group (both p < .001). The mean (range) operative time was 308 (188) minutes in the RRT group and 296 (143) minutes in the LRT group (p < .001). Pregnancy, preterm, and term birth rates were similar in the 2 groups (RRT: 18.5%, 7.4%, and 0, respectively; LRT: 29%, 8%, and 8%, respectively). Thirteen women experienced recurrent cervical cancer in the LRT group, and no recurrence was seen in the RRT group. The median (range) duration of follow-up was 8 (7.5) months in the RRT group and 34 (20) months in the LRT group (p < .001). Based on the reported data, LRT seems comparable to RRT for treating patients with early-stage cervical cancer who wish to preserve fertility.

Spondylodiscitis following sacral colpopexy procedure: is it an infection or graft rejection?

Spondylodiscitis is a rare but severe complication of sacral colpopexy (SC) procedure. Although the term 'spondylodiscitis' refers to infection of vertebral body and intervertebral disc space, neither the infecting microorganism could be isolated nor any purulent material could be observed during the second surgery and there was failure of different regimens of antibiotherapy. This type of spondylodiscitis cases might be explained by the graft rejection hypothesis. We hypothesize that the initiator of the rejection process is the host response solely and infection is just a co-incidence. In this situation, infection is neither a cause of this reaction, nor a promoter. There might be no infection at all. We presented two spondylodiscitis cases most probably secondary to graft rejection reaction and reviewed the literature in order to increase the awareness of this destructive complication of SC, which can only be ameliorated by surgical mesh removal.