Abdominal Hysterectomy with a Uterine Manipulator Minimizes Vaginal Shortening: A Randomized Controlled Trial.

BACKGROUND: We aimed to investigate the impact of adopting an uterine manipulator (UM) on the postoperative (VL) and female sexual function index (FSFI) in patients undergoing abdominal hysterectomy (AH) for benign gynecological disease. MATERIALS AND METHODS: Hysterectomies were performed with the Richardson technique; two variations, a UM or digital guidance, in this technique were used during the colpotomy step. Subjects were randomized and allocated to either hysterectomy with UM guidance (study group) or conventional hysterectomy (control group). Pre- and postoperative VL and FSFI were recorded for each patient. Additionally, surgeons' and residents' satisfaction in locating the colpotomy site was also scored by the surgical team postoperatively. RESULTS: There was a significant reduction in the VL (10.2 ± 1.2 cm vs. 8.3 ± 0.7 cm, p < 0.001) and FSFI score (21.0 ± 4.1 to 17.1 ± 3.6, p < 0.001) between the pre-operation stage and three months post-operation in the control group. However, no such significant changes were observed in the study group. Additionally, surgeons' and residents' satisfaction scores (SSS) for locating the colpotomy site were significantly higher in the study group as compared to the control group (p < 0.001). CONCLUSION: Our findings revealed that implementation of an UM in AH prevented unintended shortening of the postoperative VL and avoided a decline in the sexual function as compared to the standard AH procedure. These benefits were probably due to the precise determination of the colpotomy site that resulted from the use of UM in AH.

Do barbed sutures with different surface textures have different effects on adhesion formation and histological features? An experimental blinded study in an animal model.

BACKGROUND: The obstetrics and gynecology literature has expanded in recent years to include clinical trials assessing the use of barbed sutures. The difficulty of intracorporeal suturing continues to be a barrier to a wider use of laparoscopy. Although the use of barbed sutures has been shown to ease the process of laparoscopic suturing considerably, concerns have been raised regarding a potentially increased risk of adhesions or inflammation as a result of their use. OBJECTIVES: The aim of this study was to determine whether differences in surface textures, resulting from the variations in the geometric configurations of barbs, lead to differences in intra-abdominal adhesion formation. MATERIAL AND METHODS: A total of 27 non-pregnant female Wistar Hannover rats, weighing 200-250 g, with intact uteri were used as an adhesion formation model. The rats were randomly assigned to 3 groups: barbed suture group 1, barbed suture group 2 and control group (no intracorporeal suture). A 2-centimeter vertical incision was performed on the anti-mesosalpingeal side of one of the uterine horns. The incision on the uterine horn was reapproximated with a running suture, entailing 3 needle punctures and left untied at one end. Six weeks after the operation, intra-abdominal adhesion formations were investigated both clinically and histopathologically. RESULTS: Clinical adhesion scores and histopathological parameters in both the barbed suture groups were statistically significantly higher than in the control group (p < 0.05). There was no significant difference between the barbed suture groups regarding the adhesion scores. CONCLUSIONS: The 2 types of barbed sutures with different surface textures, used for myometrial closure, form a similar profile with respect to postoperative adhesion formation.

Advanced maternal age and risk of non-chromosomal anomalies: data from a tertiary referral hospital in Turkey.

PURPOSE: The purpose of this study is to determine if there is a relationship between non-chromosomal fetal anomalies of various organ systems and advanced maternal age. MATERIALS AND METHOD: This study was conducted in 387 women aged 20-53 years who underwent fetal karyotype testing due to positive prenatal test results or advanced maternal age at the Kanuni Sultan Süleyman Training and Research Hospital between September 2011 and March 2015. Fetuses with chromosomal anomalies were excluded from the study. The relationship between non-chromosomal anomalies and maternal age of women aged <35 or ≥35 years was studied. RESULTS: More than 80% (81.7%) of non-chromosomal anomalies were detected in patients aged <35 years, and 18.3% were found in those ≥35 years. There were no statistically significant differences found between the incidence of non-chromosomal anomalies in women aged over 35 years and those under 35 years. When congenital major anomalies were evaluated with respect to various organ systems, the risk of musculo-skeletal system anomalies decreased with advancing maternal age. However, there was no statistically significant difference between the <35 and ≥35-year age groups in the incidence of central nervous system, craniofacial, cardiac, gastrointestinal system, urogenital, respiratory, and limb anomalies. CONCLUSION: The incidence of non-chromosomal anomalies does not increase in fetuses of pregnant women aged over 35 years, in contrast to chromosomal anomalies.

Evaluation of cesarean scar after single- and double-layer hysterotomy closure: a prospective cross-sectional study.

BACKGROUND: We aimed to determine if there is a difference in the size of the cesarean scar defect using saline infusion sonography (SIS) performed on the postoperative third month in patients who underwent single- or double-layered unlocked closure of their uterine incision during their first cesarean delivery. METHODS: This study was conducted as a prospective cross-sectional study between February 2015 and January 2016 in patients admitted to the labour ward of the Kanuni Sultan Suleyman Training and Research Hospital who subsequently underwent their first delivery by cesarean section. Patients with a previous history of cesarean delivery, preterm pregnancies less than 34 gestational weeks, patients lost to follow-up or those who had an IUD inserted after delivery were excluded from the study. Out of the 327 patients who underwent primary cesarean delivery, 280 were included into the study. Patients were divided into two groups according to the single- (n:126) or double-layered (n:156) closure of their uterine incision. The maternal age, height, weight, obstetric and gynecologic histories, medical histories, indications for their cesarean delivery, technique of uterine closure, birth weight of the baby, duration of the cesarean delivery, need for extra suturing and transfusion were recorded. A Saline infusion sonography (SIS) was performed 3 months postoperatively to determine the presence, depth and length of the cesarean scar. The residual myometrial thickness overlying the scar defect and the fundal myometrial thickness were recorded. RESULTS: No difference was detected between the groups with respect to patient characteristics, whether the operation was elective or emergent, the type of anesthesia used, need for extra suturing, incidence of bladder injuries or uterine atony, need for blood transfusions, duration of labour or cervical dilatation and effacement between the two groups. No statistically significant difference was detected between the two groups with respect to the length and depth of the scar defect. CONCLUSION: Single- or double-layered closure of the uterus does not seem to affect the size of the uterine scar defect detected on SIS 3 months following the first cesarean delivery.

Predictive factors for pregnancy outcome following controlled ovarian stimulation and intrauterine insemination.

OBJECTIVE: To establish predictive factors for positive pregnancy outcome in cases of controlled ovarian stimulation and intrauterine insemination. METHODS: The retrospective study was conducted at Kanuni Sultan Suleyman Training and Research Hospital and comprised subjects having undergone ovulation induction cycles and intrauterine insemination between June 2010 and June 2015. Data was analysed in terms of various parameters affecting clinical pregnancy rates. SPSS 23 was used for statistical analysis. RESULTS: There were 475 patients having undergone a total of 923 cycles. Pregnancy was established in 133(28%) patients. Univariate analysis of biological/clinical variables revealed the presence of secondary infertility, high endometrial thickness, antral follicle number, post wash total motile sperm count and midluteal progesterone levels following intrauterine insemination to be associated with positive pregnancy outcomes (p<0.05 each). Multiple logistic regression analysis was performed to establish factors that affected the pregnancy rate. The aetiology and type of infertility and high midluteal progesterone levels following intrauterine insemination were found to be statistically significant predictors of pregnancy (p<0.05 each). CONCLUSIONS: The best chance of pregnancy was found in cases with anovulatory infertility, a history of prior pregnancy, and high midluteal progesterone levels following treatment with gonadotrophins and intrauterine insemination.