Transumbilical single-incision total laparoscopic hysterectomy: technique and initial experience in Turkey.

OBJECTIVES: The aim of the study is to determine the results of our initial experience of 32 cases who underwent single incision total laparoscopic hysterectomy MATERIALS AND METHODS: Thirty-two patients who underwent transumbilical single incision total laparoscopic hysterectomy between March 2009 and February 2011 were reviewed retrospectively at the Department of Obstetrics and Gynecology Ege University Faculty of Medicine, Izmir, Turkey Articulating and rigid instruments, 30 degrees 10 mm telescope, SILS port and advanced bipolar and mechanical energy modalities were used during the procedure. Duration of surgery length of hospital stay mean blood loss and postoperative complications were assessed. RESULTS: Mean age of patients and mean operation time were 48 years (ranged 42-55) and 108 minutes (ranged 80-180), respectively. In all cases vaginal cuffs were closed with either intracorporeal or extracorporeal separate sutures. There were no intraoperative complications. All patients were discharged within 48 hours postoperatively The mean length of hospital stay and mean blood loss were as 1.6 days (range 1-2) and 45 ml (range 30-100), respectively CONCLUSIONS: Total laparoscopic hysterectomy performed through transumbilical single incision is technically feasible and safe. Development of advanced flexible instrumentation and visualization platform may facilitate this new operative approach.

Osteoprotective effect of hormone therapy on bone microarchitecture before impaired bone mineral density in ovariectomized rats.

OBJECTIVE: We aimed to determine the effect of hormone replacement therapy on bone microarchitecture in ovariectomized rats. MATERIAL AND METHODS: In the Animal Ethics Committee approved-study, the effect of treatment with 17 ß-estradiol 50 µg/kg and medroxyprogesterone 2.5 mg/kg on bone architecture and bone mineral density in rats versus ovariectomized control rats over the course of 20 days were evaluated. Femoral and lumbar bone mineral density levels and morphometric measurements were performed. RESULTS: There were no significant differences in the femoral and lumbar bone mineral density levels between the groups. In the intact control group, the trabecular structures were significantly superior to those in the other groups. Additionally, the osteoblast count was significantly higher while the osteoclast count was significantly lower than in all other groups. Two parameters reflecting trabecular bone microarchitecture, which include the trabecular count and the trabecular area, demonstrated significant improvement in the hormone replacement group when compared to the ovariectomized control group. In the hormone replacement groups, the osteoblast count was significantly higher while the osteoclast count was significantly lower than in the ovariectomized control group. CONCLUSION: We suggest that offering estrogen alone or in combination with progestogen can be a beneficial approach in preventing early postmenopausal bone loss regardless of bone mineral density.

Effects of ovariectomy and tamoxifen on rat bone tissue: histomorphometric and histopathologic study.

OBJECTIVE: To investigate possible detrimental effects on bone tissue induced by ovariectomy and tamoxifen (TMX) using bone densitometry and histomorphologic analysis. STUDY DESIGN: Twenty-four rats were allocated into 4 groups: group 1, intact normal rats (n = 6); group 2, ovariectomized rats (n = 6); group 3, normal female rats that received 1 mg/kg/day TMX dissolved in dimethyl sulfoxide (DMSO) for 2 months (n = 6); group 4, normal female rats that received DMSO for the same duration and with a volume equal to that of TMX (n = 6). Results of histomorphometric analysis for trabecular thickness, number of osteoblasts and osteoclasts, trabecular number, and area and cortical thickness were compared. RESULTS: No significant effects of ovariectomy on femoral or lumbar bone mineral density (BMD) were found. In the TMX group, the value of femoral BMD increased significantly compared to control group cellular and pathologic changes. TMX caused significant decrease in osteoblasts compared to the control group. CONCLUSION: TMX has a positive effect on inorganic bone tissue, but a negative effect on number of osteoblasts and osteoclasts. Future studies investigating estrogenic and antiestrogenic effects of TMX should include cellular parameters related to proliferation using histopathologic and histomorphometric analyses.

Does tibolone affect serum leptin levels and body weight in postmenopausal women?

OBJECTIVES: Leptin has a significant role in body weight regulation and energy balance. We examined the effect of tibolone on the body weight and serum leptin levels in postmenopausal women. STUDY DESIGN: Twenty women (aged 43-60 years) participated in this prospective study. All women in this study protocol received 2.5 mg/day of tibolone. Absolute and body mass index (BMI)-corrected serum leptin concentrations and BMI values were measured at baseline, after 3 months, and after 6 months of the tibolone therapy. RESULTS: Tibolone did not affect absolute and BMI-corrected serum leptin levels, and BMI values during the treatment. A significant linear correlation between BMI values and serum leptin levels was observed (p<0.05, r=0.67). CONCLUSIONS: Tibolone seems not to affect serum leptin levels, body weight and BMI values of postmenopausal women. There is a significant correlation between serum leptin levels and BMI values.

The effect of mid-luteal estradiol level on the outcome of ICSI-ET cycles.

METHODS: We investigated if mid-luteal estradiol levels could predict the outcome in intracytoplasmic sperm injection embryo transfer (ICSI-ET) cycles ( n=231). Pregnant and non-pregnant women were compared regarding their peak estradiol levels on human chorionic gonadotropin (hCG) injection day, and mid-luteal estradiol levels on the 7th day following oocyte recovery. Pregnancy rates of the groups that were designed according to the "peak/mid-luteal estradiol level" and the mid-luteal estradiol levels were also compared. RESULTS: Peak and mid-luteal estradiol levels in pregnant women were higher than in non-pregnant women in all patients, although the difference between peak and mid-luteal estradiol levels were similar in pregnant and non-pregnants. Pregnant women had higher mid-luteal estradiol levels in good responders, but the peak estradiol levels of pregnant and non-pregnant women were similar. In poor responders, pregnant and non-pregnant women were similar with respect to peak and mid-luteal estradiol levels. Both in all patients and good responders, women with mid-luteal estradiol levels <200 pg/ml had lower pregnancy rates than those with >2000 pg/ml. Peak/mid-luteal estradiol ratios of pregnant and non-pregnant women were not significantly different in all patients, good responders and poor responders; although a tendency for a lower ratio in pregnants was encountered in good responders. Pregnancy rates of the groups according to the "peak/mid-luteal estradiol ratio" were similar; in all patients, good responders and poor responders. CONCLUSION: A relation between the mid-luteal estradiol level and the outcome is encountered only in good responders.

Effects of coasting on the outcome of intracytoplasmic sperm injection-embryo transfer cycles.

OBJECTIVES: To determine the effects of 'coasting' on the outcome of controlled ovarian hyperstimulation (COH) and intracytoplasmic sperm injection-embryo transfer (ICSI-ET). DESIGN: Retrospective study. SETTING: IVF Centre, Ozel Ege Tup Bebek Merkezi, Izmir, Turkey. SAMPLE: Twenty-six coasted and 52 non-coasted COH and ICSI-ET patients were enrolled in this retrospective study. METHODS: Coasted patients were enrolled consecutively during the study period, and two non-coasted controls were selected from our database for each coasted patient. Coasting was decided when serum oestradiol level was > or = 4000 pg/mL. Groups were compared using chi2 and Mann-Whitney U-tests for statistical analysis. MAIN OUTCOME MEASURES: Number of oocytes collected, metaphase II (MII) oocytes and cleaving embryos, the fertilisation rate and clinical pregnancy rate were the main outcome measures. RESULTS: Number of oocytes collected, number of MII oocytes, number of cleaving embryos, fertilisation rate and clinical pregnancy rate for the coasted and non-coasted groups were 15.5 +/- 5.2 and 14.0 +/- 7.1, 9.7 +/- 4.8 and 9.3 +/- 3.9, 6.8 +/- 3.9 and 5.8 +/- 3.1, 0.85 +/- 0.18 and 0.78 +/- 0.18, 13/26 and 24/52, respectively; these differences were not statistically significant. None of the patients in the coasted group were hospitalised for signs or findings of severe ovarian hyperstimulation syndrome. CONCLUSIONS: Coasting does not adversely affect the number and the function of mature oocytes and the clinical pregnancy rate.