Laparoscopic sacral colpopexy with polyester fiber suture: Ozerkan modification.

INTRODUCTION AND HYPOTHESIS: Mesh-related problems are significant complications of laparoscopic sacral colpopexy. The conventional technique precludes performing laparoscopic sacral colpopexy without using a mesh. We describe the Ozerkan modification for laparoscopic sacral colpopexy using a polyester fiber suture instead of a standard mesh and report 1-year objective and subjective outcomes. METHODS: Women diagnosed with stage ≥ 2 vaginal vault prolapse were prospectively recruited for the Ozerkan modification between 2015 and 2017. The primary outcome was the anatomic success of the repair, defined by objective parameters using the pelvic organ prolapse quantification system (stage 0 or 1). Secondary outcomes were subjective outcomes assessed with the quality of life scores. RESULTS: Twenty-two women underwent the Ozerkan modified laparoscopic sacrocolpopexy. Mean operation time was 85.6 min. Mean estimated blood loss was 71 ml. One patient was lost during the clinical follow-up in the outpatient clinic up to 1 year. Nineteen of 21 patients had stage 0 or 1 prolapse at the end of 1 year. Two patients were not satisfied with their pelvic floor after 1 year. Both the objective and subjective cure rates were 90.4%. There were no bladder or bowel complications during the peri- or postoperative period. CONCLUSIONS: The new modification of laparoscopic sacral colpopexy seems a feasible and safe option to avoid mesh complications in the treatment of vaginal vault prolapse.

Social media awareness among non-urogynecologists regarding the current mesh discussions in urogynecology: a survey study.

INTRODUCTION AND HYPOTHESIS: There has been a great deal of discussion about mesh complications in urogynecology in recent years. However, awareness of other doctors who are not urogynecologists is unknown. This study was aimed at determining the level of awareness of mesh discussions among medical doctors whose specialty is not urology or gynecology. METHODS: A survey study was administered, and all medical doctors, except gynecologists and urologists, were invited. Respondent doctors were classified into four groups: King's College Hospital (KCH), UK; Uludag University Hospital (UUH), Turkey; the United States (USA); and the world (WORLD). The primary outcome was the awareness of mesh discussion in urogynecology, and the secondary outcome was the social media awareness of the mesh discussion. RESULTS: 1231 doctors responded to the survey. The awareness of the current mesh problems among the respondent doctors was 15.8% in KCH, 15.4% in UUH, 26.9% in the USA, and 16.2% in WORLD. The social media awareness about mesh problems was 20.8% in KCH, 20.3% in UUH, 32.8% in the USA, and 20.6% in WORLD. Although there were no differences among three of the groups with regard to primary and secondary outcomes, the USA group score was statistically significantly higher than the others. CONCLUSIONS: Social media can influence doctors' thinking on controversial academic issues. In this survey study, non-urogynecologist doctors in the USA cohort have higher awareness levels and a higher social media awareness level than other groups.

A Meshless Practical Laparoscopic Sacrohysteropexy Modification and Long-term Outcomes.

STUDY OBJECTIVE: To describe a new modification of laparoscopic sacrohysteropexy without using a mesh and report the 3-year outcomes. DESIGN: A prospective cohort study. SETTING: Minimally Invasive Gynecology Unit, Bursa Uludag University Hospital, Turkey. PATIENTS: Women who were diagnosed with ≥ stage 2 uterine prolapse. INTERVENTIONS: A laparoscopic sacrohysteropexy modification using a polyester fiber suture instead of a standard polypropylene mesh. MEASUREMENTS AND MAIN RESULTS: The primary outcome was the anatomic success of the repair, with success defined as objective parameters using the pelvic organ prolapse quantification system. The secondary outcomes were subjective outcomes, which were assessed using the quality-of-life scales. Forty-seven women who underwent the procedure were followed up for a minimum of 3 years. Forty-four of the 47 patients had stage 0 or 1 prolapse at the end of the second year, according to the primary outcomes. The anatomic success rate was 93.6%. In the secondary outcomes, 2 patients were not satisfied with their pelvic floor after the second year. The subjective cure rate was 95.7%. There was a statistically significant improvement in both pelvic organ prolapse quantification and quality-of-life scores in the third postoperative year. The mean operating time was 84.6 minutes, and the mean estimated blood loss was 21.3 mL. There were no bladder or bowel complications in the perioperative or postoperative period. CONCLUSION: Laparoscopic sacrohysteropexy can be performed safely with this meshless modification in uterine prolapse as an alternative.

From Where Does the Uterine Artery Originate? A Prospective, Observational Laparoscopic Anatomic Study.

STUDY OBJECTIVE: To determine and categorize the anatomic variations of the uterine artery (UA) as observed during laparoscopic hysterectomy with retroperitoneal dissection for benign conditions. DESIGN: A prospective, observational study. SETTING: A hospital department of obstetrics and gynecology, Uludag University Hospital, Bursa, Turkey. PATIENTS: A total of 378 female patients who presented with indications for laparoscopic hysterectomy for benign disease. INTERVENTIONS: Laparoscopic hysterectomy with retroperitoneal dissection was performed bilaterally in all patients between March 2014 and October 2018. The vascular anatomy beginning at the bifurcation of the common iliac artery down to the crossing of the UA with the ureter was exposed and subsequently studied. The UA was identified, and its variable branching patterns were recorded. The patterns were then categorized into groups adapted from classic vascular anatomy studies. MEASUREMENTS AND MAIN RESULTS: Retroperitoneal dissections of 756 UAs were performed in 378 female patients. The UA was the first anterior branch of the internal iliac artery in 80.9% of the cases (Model 1; Main Model). Three additional models adequately described other variations of the UA as follows: Model 2 (Cross Model), 3.7%; Model 3 (Trifurcation Model), 3.1%; and Model 4 (Inverted-Y Model), 7.4%. The origin of the UA could not be determined in 7.4% of the cases. CONCLUSION: The UA is the first anterior branch of the internal iliac artery in more than 80% of females. Surgeons should be aware of the anatomic variations of the UA to perform safe and efficient procedures.

Long-term follow-up of laparoscopic sacrocolpopexy: comparison of two different techniques used in urology and gynecology.

INTRODUCTION AND HYPOTHESIS: Numerous studies have found that the short-term results of laparoscopic sacrocolpopexy for pelvic organ prolapse are safe and effective. This study evaluates the long-term results of the laparoscopic sacrocolpopexy operation between the urology and gynecology branches. METHODS: A prospective study enrolling 206 patients was conducted to evaluate laparoscopic sacrocolpopexy as a surgical treatment for vaginal vault prolapse from 2011 to 2014. Two different surgical branches (urology and gynecology) applied laparoscopic sacrocolpopexy to their patients with their own techniques. The long-term results were assessed postoperatively after 4 years by pelvic examinations, including the Pelvic Organ Prolapse Quantification system (POP-Q) and quality-of-life assessments using validated questionnaires. RESULTS: A total of 190 patients (94 urology and 96 gynecology patients) received a full clinical follow-up examination between April 2014-June 2018. Postoperative pelvic organ prolapse recurrence rates in each compartment were similar in both groups during the 4 years; 87.2% of the urology and 86.5% of the gynecology patients had no prolapse in any compartment according to the POP-Q system. The reoperation rate was 5.3% for the urology and 6.2% for the gynecology group. Mesh erosion was detected in two patients in both groups. Three patients responded to local estrogen therapy, and we removed the mesh vaginally in one patient. The subjective cure rate was 89.4% in the urology and 88.5% in the gynecology group after 4 years. CONCLUSIONS: Although different surgical branches perform laparoscopic sacrocolpopexy with their own techniques, long-term anatomical and functional results are similar between the branches. From a urogynecological point of view, laparoscopic sacrocolpopexy is a gold standard surgical procedure that can be performed by both urologists and gynecologists with similar long-term outcomes.

Laparoscopic Evacuation of an Early Pregnancy.

STUDY OBJECTIVE: Minimally invasive surgical procedures have shown significant improvement over the last 20 years. Today, nearly half of the surgeries, including oncology, are performed with minimally invasive methods. In obstetrics and gynecology surgery practice, laparoscopy can now be used in almost all operations. In this video, we performed a laparoscopic evacuation of a 12-week missed abortion case like a cesarean section at the time of bilateral salpingectomy. DESIGN: A case report (Canadian Task Force classification III). SETTING: A tertiary referral center in Bursa, Turkey. PATIENT: A 38-year-old patient. INTERVENTION: Laparoscopic evacuation of the pregnancy product (like a cesarean section) and bilateral salpingectomy. The local institutional review board approved the video. MEASUREMENTS AND MAIN RESULTS: Gravida: 4, parity: 3. The patient was in the 12th week of her gestation when we diagnosed a missed abortion. In situs of the operation, there was a 12-week pregnancy filling the pouch of Douglas. We clipped the uterine arteries bilaterally and retracted the bladder flap to create a safe surgical incision in the low anterior segment of the uterus. We used the monopolar cautery to incise the uterus from superior to inferior similar to the low vertical classic uterine incision in the cesarean section. The abortus material was removed with the laparoscopic endobag, and bilateral salpingectomy was performed. CONCLUSION: Developments in minimally invasive surgery are progressing day by day. As advances in laparoscopic and robotic surgery progress, complicated surgical procedures would be done efficiently.

Anatomic and Functional Outcomes of Paramesonephric Remnant-Supported Laparoscopic Double-Layer Peritoneal Pull-Down Vaginoplasty Technique in Patients with Mayer-Rokitansky-Küster-Hauser Syndrome: Uncu Modification.

OBJECTIVE: To describe modifications to the double-layer peritoneal pull-down laparoscopic vaginoplasty technique (Davydov operation) and evaluate anatomic and functional outcomes of the new technique, known as the Uncu modification. DESIGN: Case series (Canadian Task Force classification III). SETTING: Tertiary care university hospital. PATIENTS: Women with Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS) who underwent surgery between 2010 and 2016. INTERVENTIONS: Laparoscopic double-layer peritoneal pull-down vaginoplasty with paramesonephric remnant support to the neovagina. MEASUREMENTS AND MAIN RESULTS: Long-term anatomic and functional satisfaction results. Twenty-seven women with MRKHS underwent surgery with the Uncu-modified Davydov procedure. At 1 year after surgery, the mean vaginal length in these patients was 7.91 ± 1.4 cm. Among the 23 patients who had regular vaginal intercourse, the mean functional satisfaction score was 8.65 ± 1.2. One patient had a perioperative bladder injury, and another patient had a rectovaginal fistula at 3 months after the operation. One woman who did not comply with the prescribed postoperative mold exercises had complete closure of the introitus. CONCLUSION: The Uncu modified laparoscopic double-layer peritoneal pull-down technique appears to be an effective and safe surgical management option that is easy to learn and perform by gynecologic surgeons.

Prospective assessment of the impact of endometriomas and their removal on ovarian reserve and determinants of the rate of decline in ovarian reserve.

STUDY QUESTION: Do the presence of endometriomas and their laparoscopic excision lead to a decrease in ovarian reserve as assessed by serum anti-Müllerian hormone (AMH) levels? SUMMARY ANSWER: Both the presence and excision of endometriomas cause a significant decrease in serum AMH levels, which is sustained 6 months after surgery. WHAT IS KNOWN ALREADY: No previous comparison of serum AMH levels between women with and without endometrioma has been reported. However, studies have suggested a decline in serum AMH levels 1-3 months after endometrioma excision but long-term data are needed. STUDY DESIGN, SIZE, DURATION: A prospective cohort study including 30 women with endometrioma >2 cm were age matched with 30 healthy women without ovarian cysts. PARTICIPANTS/MATERIALS, SETTING, METHODS: Women with endometrioma underwent laparoscopic excision with the stripping technique. Serum AMH level and antral follicle count (AFC) were determined preoperatively, 1 and 6 months after surgery. Correlation analyses were undertaken in order to identify determinants of surgery-related change in ovarian reserve. MAIN RESULTS AND THE ROLE OF CHANCE: Compared with controls at baseline, women with endometrioma had lower AMH levels (4.2 ± 2.3 versus 2.8 ± 2.2 ng/ml, respectively, P = 0.02) and AFC (14.7 ± 4.1 versus 9.7 ± 4.8, respectively, P < 0.01). Serum AMH levels were further decreased 6 months after surgery (2.8 ± 2.2 versus 1.8 ± 1.3 ng/ml, P = 0.02), while AFC remained unchanged (9.7 ± 4.8 versus 10.4 ± 4.2, P = 0.63). The rate of decline in AMH was not correlated with age, laterality of endometrioma, cyst diameter or the number of primordial follicles on the surgical specimens. The preoperative serum AMH level was positively correlated with the rate of decline in serum AMH after surgery (r = 0.47, P = 0.02). LIMITATIONS, REASONS FOR CAUTION: The absence of a non-treated group of women with endometriomas as a further control prevents comment on the presence of a progressive decline in ovarian reserve related to endometrioma per se. The sample size may be too small for detection of factors correlated with the extent of ovarian damage. WIDER IMPLICATIONS OF THE FINDINGS: While the findings are mostly in agreement with previous studies, the present study is the first to show that the presence of endometrioma per se is associated with a decrease in ovarian reserve. The extent of surgery-related decline in ovarian reserve is not predictable using preoperative or perioperative factors. It may be prudent to measure AMH levels preoperatively and delay/avoid surgical excision as far as is possible if subsequent fertility is a concern. Additional studies are required to further investigate whether the endometrioma-related decline in ovarian reserve per se is progressive in nature and whether it exceeds the surgery-related decline. STUDY FUNDING/COMPETING INTEREST(S): This study was funded by the Research Fund of the Uludag University School of Medicine. The authors have no conflict of interest associated with this study.

Clinical significance of risk-reducing salpingo-oophorectomy in patients with BRCA1/2 mutation.

OBJECTIVE: Serous tubal intraepithelial carcinoma (STIC) is a precursor lesion which is located in the distal fallopian tube and causes high grade serous ovarian carcinoma (HGSOC). The incidence of STIC for women underwent risk reducing salpingo-oophorectomy for BRCA mutation varies from 0.6 to 7% and its clinical outcomes are still unclear. The aim of this study was to demonstrate the incidence of STIC and HGSOC in BRCA1/2 mutation carriers after risk reducing salpingo-oophorectomy (RRSO) and the clinical outcomes of these patients. MATERIAL AND METHODS: We retrospectively reviewed the records of 48 BRCA1 and/or 2 mutation carriers who underwent prophylactic salpingo-oophorectomy with or without hysterectomy at the Department of Obstetrics and Gynecology, Bursa Uludag University between January 2000 and January 2022. INCLUSION CRITERIA: BRCA 1 and/or 2 mutation carriers diagnosed by genetic testing, asymptomatic patients with no abnormal findings on pelvic examination. EXCLUSION CRITERIA: patients with no abnormal findings on pelvic examination and a presence of a personal history of ovarian, fallopian tube or peritoneal cancer. RESULTS: A total of 48 BRCA 1 and/or 2 mutation carriers underwent RRSO. STIC was diagnosed in 1 (2,0%) patient and restaging surgery was not performed. Primary peritoneal carcinoma (PPC) did not develop during the 20 months follow-up period. One (2.0%) patient was diagnosed with occult ovarian cancer. Restaging surgery was performed and chemotherapy treatments were given after surgery. A pelvic recurrence developed 25 months after the occult cancer diagnosis in the follow up period. One (2.0%) patient with normal histopathological findings after RRSO was diagnosed with peritoneal cancer 57 months after the operation. CONCLUSION: The risk of PPC continues after RRSO. Therefore, close follow-up procedure is very important for early diagnosis and effective treatment of patients with PPC after RRSO.

Comparison of magnesium sulfate and mannitol in treatment of eclamptic women with posterior reversible encephalopathy syndrome.

OBJECTIVE: To evaluate and compare the effectiveness of magnesium sulfate (MgSO(4)) and mannitol in the treatment of posterior reversible encephalopathy syndrome (PRES) in eclamptic women. STUDY DESIGN: This retrospective analysis includes 62 eclamptic women between 22 and 40 weeks of gestation who were diagnosed with PRES in a tertiary care center. To treat neurological symptoms, 34 women received magnesium sulfate (Group 1) and the remaining 28 received 20% mannitol (Group 2) at the discretion of treating physician. RESULTS: Ten patients from both Group 1 (29%) and Group 2 (35.7%) were normotensive at admission. 59 of 62 patients presented with seizure. All patients underwent fluid attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI). Parietooccipital region and cerebellum were the most commonly affected areas. The duration of treatment was significantly shorter in Group 1 than Group 2 (p < 0.001). Neurological examinations and the recovery after treatment were significantly better in favor of MgSO(4) group (p = 0.039). CONCLUSION: Mannitol is not superior to magnesium sulfate in achieving neurological recovery. Magnesium sulfate seems to be the agent of choice for treatment of PRES.

Menstrual pattern following tubal sterilization.

BACKGROUND: We sought to investigate the effects of tubal sterilization over menstrual parameters and determine the timing of the detected influences. MATERIAL/METHODS: We questioned 97 voluntary patients among 301 women who had been subjected to tubal sterilization in our clinic between 1996-2006. Patients were asked via questionnaire about menstrual parameters concerning the 5 years before and after the surgery, which focused on each year separately. Statistical analyses were carried out by considering the preoperative data of patients as controls and postoperative data as the study group. RESULTS: Some kind of pattern change was detected in 7.6% of all patients. Hemorrhage with chunky clots of blood incidence decreased significantly by the second postoperative year (31.9%, 21.6%; P<.05). We had a significant decrease in dysmenorrhea postoperatively in the third, fourth, and fifth years (38.1%, 21.6%, 16.4%, 13.4%; P<.05). While the premenstrual syndrome was 45.3% before surgery, it was 30.9% and 24.7% postoperatively in the fourth and fifth years (P<.05). CONCLUSIONS: Hemorrhage and dysmenorrhea were most frequently seen after tubal sterilization. The statistically significant drop in the mean weekly coital frequency during postoperative period indicates a need for further studies, which might evaluate the reasons behind this reduction.

Mesh complications on YouTube.

OBJECTIVE: There has been a heated discussion about mesh materials in urogynecology in recent years. The role of social media in this discussion is critical. This study aims to make a systematic analysis of videos uploaded to YouTube about mesh complications in urogynecology. STUDY DESIGN: YouTube was searched using specific terms about mesh materials. The primary outcome was the relationship between the video characteristics -which were publisher identity, attitude, the main focus of the video country, and year- and the mesh debate in urogynecology. RESULTS: We analyzed 1128 YouTube videos about mesh complications. There was no distinction between stress urinary incontinence and pelvic organ prolapse when referring to the mesh material in 79 % of the videos. 35.2 % of the videos were in the News group, 31.2 % were in the Patients group, 19.6 % were in the Doctors group, and 14.0 % were in the Lawyers group. Videos in the News (75.7 %), Patients (92.6 %), and Lawyers (99.4 %) groups mostly had a negative attitude, while videos in the Doctors (48.9 %) group mostly had an informative attitude. News (43.2 %) and Patients (51.2 %) group videos were predominantly from the United Kingdom. However, Lawyers (81.0 %) and Doctors (44.3 %) videos were predominantly from the USA. In the last three years, the news and patients videos have increased by an average of 40 % each year. CONCLUSION: YouTube has influenced the mesh dilemma with a negative attitude. As long as social media is at the center of this discussion, a healthy outcome cannot be achieved.

Does antenatal magnesium sulphate improve hearing function in premature newborns?

Objective: To evaluate whether antenatal magnesium sulphate (MgSO4) exposure has a neuroprotective effect against hearing impairment in premature newborns. Material and Methods: Retrospective cohort study was performed with prematurely (<37 weeks) delivered newborns at a tertiary university hospital. Newborns of 92 women who received MgSO4 infusions (study group) for various indications were compared to newborns of 147 women who did not receive MgSO4 infusions (control group). All eligible premature newborn underwent hearing screening by auditory brainstem response (ABR) testing before being discharged from the hospital. Results: The fail rate for ABR hearing screening was 3.3% (n=3) in the study group and 10.9% (n=16) in the control group (p=0.034). The rate of concurrent use of betamethasone was higher in the study group (72.8%; n=67) compared to control group (29.2%; n=43) (p<0.001). Other neonatal parameters, such as the number of neonates who were small for gestational age and the rate of microcephaly were similar between the groups (p=0.54, p=0.48, respectively). After adjusting for co-variates including the use of betamethasone and gestational age at delivery, no statistically significant association between antenatal administration of MgSO4 and ABR fail rates were found (p=0.07). Conclusion: These results do not suggest a significant benefit in terms of hearing impairment in premature newborns when antenatal MgSO4 infusion was given.

Effectiveness of Omura's ST.36 point (True ST.36) needling on the Wingate anaerobic test results of young soccer players.

The purpose of this study was to investigate the effectiveness of the "Omura's ST.36 point" (True ST.36) needling of young soccer players with the Wingate test. The Wingate test is a widely used and very well known ergometric bicycle test to measure anaerobic power. The Bi-Digital O-Ring Test (B.D.O.R.T.) of Yoshiaki Omura, M.D., Sc.D. was used to determine the "Omura's ST.36 point" (True ST.36). Young soccer players (N = 20) between 15-16 years of age (Mean = 15.25 +/- 0.44) were involved in the study. Subjects were divided into two groups (ST.36 and Omura's ST.36) randomly. The groups were statistically similar in respect to their number, age, height and weight respectively, N = 10; 15.40 +/- 0.52, 15.10 +/- 0.32; 171.50 +/- 3.57, 171.00 +/- 4.81; 65.60 +/- 4.01, 61.50 +/- 4.77. The anaerobic power of the subjects were measured using Monark 894E ergometric bicycle. The breaking resistance was 75 g per kg of body weight of the subjects. The peak power, average power, minimum power and power drop were measured as absolute values and per kg of body weight. Subjects were tested twice, with and without acupuncture application. In one group needling was on ST.36, and in the other group it was on "Omura's ST.36 point." Before each test, subjects warmed up for 5 minutes by cycling on the same ergometer at 60 rotations per minute (RPM), without load. Statistically significant increases were measured with the needling of Omura's ST 36 point in peak power (p < 0.01), and relative peak power (p < 0.01) in comparison to Wingate test results without needling. ST.36 needling showed statistically insignificant increases of the same measurements and comparison. We conclude that needling of both points, but especially Omura's ST.36, seem to be effective for increasing the anaerobic power of young soccer players measured with Wingate anaerobic power test. More research is needed to support these findings in all aspects.

Different treatment modalities and outcomes in cesarean scar pregnancy: a retrospective analysis of 31 cases in a university hospital.

OBJECTIVES: There is no standardized treatment modality or a generally accepted guideline in cesarean scar pregnancy (CSP) treatment. The aim of this study is to retrospectively evaluate the outcomes of the different treatment modalities used in CSP treatment. MATERIAL AND METHODS: 31 CSP patients retrospectively evaluated between May 2011 and February at Uludag University Hospital in Bursa, Turkey included in the study. A graphical flowchart according to the treatment modalities and timeline graphics of the patients were used. Main outcome measures were recurrent CSPs and healthy pregnancies in clinical follow-up after a successful CSP treatment. RESULTS: 31 CSP patients were treated with six different treatment modalities in our series. Recurrent CSP was diagnosed in three patients after a successful CSP treatment. All of these recurrent CSPs were treated with D/C procedure in their first CSP. Six patients conceived again in clinical follow-up after successful treatment of CSP. CONCLUSIONS: CSP is a serious maternal complication that risks the mother's life, and this problem is growing because of the increased cesarean rates. Invasive procedures applied to the uterus in CSP treatment may cause recurrent CSP in the next pregnancy of the patient. When considering the treatment options of the CSP, minimally invasive treatment modalities and the subsequent gestation of the patient should be taken into account.

The Comparison of Outcomes between the "Skeleton Uterus Technique" and Conventional Techniques in Laparoscopic Hysterectomies.

AIM: The aim of this study is to compare demographic characteristics, operative data, and complication rates of women who underwent total laparoscopic hysterectomy by the skeleton uterus technique (Skeleton-TLH) with those of women who underwent TLH by the standard technique (Standard-TLH) in a university teaching and research hospital. MATERIALS AND METHODS: This retrospective study included 932 laparoscopic hysterectomies in a university teaching and research hospital between January 1, 2013 and December 31, 2017. Clinical characteristics, operative outcomes, and complications were recorded and compared for the two techniques. RESULTS: In total, 932 laparoscopic hysterectomies were performed, 454 by Skeleton-TLH and 478 by Standard-TLH. The general demographic characteristics of the patients were similar; only gravida and parity were statistically significantly different between the groups (P < 0.001). Based on the primary outcomes (the operative data), total anesthesia time and main operation time were similar in the two groups. Estimated blood loss was statistically significantly lower in the Skeleton-TLH group than in the Standard-TLH group. Hospital stay was longer for the Skeleton-TLH group, and specimen weight was heavier. The secondary outcome was the complication rate. There were no differences between the Skeleton-TLH and Standard-TLH groups in the rates of all minor and major complications. CONCLUSION: TLH with the skeleton uterus technique is feasible and safe, especially for advanced pelvic surgeons. This technique not only provides retroperitoneal access to the pelvic spaces and good anatomical visibility; but it also delivers a safer laparoscopic hysterectomy by clamping the uterine arteries and monitoring the ureter throughout the operation.

Laparoscopic hysterectomy trends in challenging cases (1995-2018).

OBJECTIVE: To investigate the effect of challenging factors on laparoscopic hysterectomy trends within twenty-four years. POPULATION AND METHOD: This was a trend analysis study of 7558 women who underwent hysterectomy for benign indications between 1995-2018 in Bursa Uludag University Hospital, Turkey. A trend analysis of obesity, previous laparotomy (≥3) and uterine specimen weight (≥500g) was applied for abdominal hysterectomy (TAH), vaginal hysterectomy (VH), and laparoscopic hysterectomy (TLH) rates in this period. The primary outcome was laparoscopic hysterectomy trends throughout the years. We measured the effect of obesity, previous laparotomies and large uterus on TLH trends as secondary outcomes. RESULTS: The ratio of TLHs to all hysterectomies was 2.4% in 1995 and 44.7% in 2018 which increased 33 times higher over 24 years. The percentage of obese patients in TLH cases increased from 1% to 37%, the rate of patients who had three or more previous laparotomy in TLH cases increased from 0% to 32.2%, and the percentage of patients who had more than 500g uterus specimen in laparoscopic hysterectomy cases increased from 0% to 32.8%. CONCLUSION: Laparoscopic hysterectomy trends are increasing in challenging cases. Obesity, previous surgeries, and large uteruses are no longer a limiting factor for laparoscopic hysterectomy.

Comparison of the effectiveness of the traditional acupuncture point, ST. 36 and Omura's ST.36 Point (True ST. 36) needling on the isokinetic knee extension & flexion strength of young soccer players.

The purpose of this study was to compare the effects of the Traditional acupuncture point ST.36 and 'Omura's ST.36 Point' ("True ST.36") needling on the isokinetic knee extension & flexion strength of young soccer players. The Bi-Digital O-Ring Test (B.D.O.R.T.) of Yoshiaki Omura, M.D.,Sc.D. was used to determine the "True ST.36". Young soccer players (N = 24) between 16-18 years of age (Mean = 16.92 +/- 0.65) were involved in the study. The extension & flexion strengths of dominant legs were measured with Cybex 350 Extremity System isokinetically. The testing velocity was 60 degrees/sec. The peak torque value in Newton meters (Nm) was evaluated. Subjects were tested 3 times. Extension & Flexion 1 (EXT1, FLEX1) without acupuncture application, EXT2 & FLEX2 after application on the traditional acupuncture point, ST.36 and EXT3 & FLEX3 after application onto the 'Omura's New Foot-point' ("True ST.36"). Before each test, subjects warmed up for 10 minutes by cycling on an isokinetic ergometer at 50 RPM, 75 Watts load followed by stretching exercises of lower extremity. Mean EXT1, EXT2, EXT3 values were 196.92 +/- 28.70: 210.00 +/- 23.00; 224.42 +/- 21.70 respectively, where FLEX1, FLEX2, FLEX3 were 140.88 +/- 22.45; 151.13 +/- 21.27; 161.00 +/- 22.23. Comparisons of EXT1-EXT2, EXT1-EXT3, EXT2-EXT3, FLEX1-FLEX2, FLEX1-FLEX3, FLEX2-FLEX3 strength values showed all very high significance (P < 0.001) in favor of 1) Needling on relevant points and 2) Omura's ST.36 Point ("True ST.36"). We conclude that B.D.O.R.T. can help to determine new (True) Acupuncture points and, both points were effective for increasing the isokinetic knee extension & flexion strength of young soccer players very significantly where as Omura's ST.36 Point ("True ST.36") was more effective than Traditional Acupuncture point, ST.36.