Left Atrial Coupling Index Predicts Heart Failure in Patients with End Stage Renal Disease.

Background and Objectives: We aimed to ascertain the predictive power of the left atrial coupling index (LACI) in patients with end stage renal disease (ESRD) for heart failure with preserved ejection fraction (HFpEF). Materials and Methods: This is a retrospective study including 100 subjects between 18 and 65 years of age with ESRD and not on dialysis treatment. Patients were divided into groups with and without HFpEF. The LACI was defined as the ratio of the left atrial volume index (LAVI) to the a' wave in tissue Doppler imaging (TDI). Statistical analyses were performed, including univariate and multivariate regression analyses. Results: The mean age of the participants was 47 ± 13.3 years. Individuals with HFpEF exhibited a higher LACI. Univariate and multivariate regression analyses demonstrated that the predictive capacity of the LACI for HFpEF was considerably higher than that of the LAVI and other echocardiographic parameters. Conclusions: Higher LACI levels were consistently related to the presence of HFpEF in ESRD patients. The LACI can be easily obtained in daily practice using conventional Doppler echocardiographic measurements during left atrial functional assessments.

A Compact Modified Two-Arm Rectangular Spiral Implantable Antenna Design for ISM Band Biosensing Applications.

This paper presents a new microstrip implantable antenna (MIA) design based on the two-arm rectangular spiral (TARS) element for ISM band (Industrial, Scientific, and Medical 2.4-2.48 GHz) biotelemetric sensing applications. In the antenna design, the radiating element consists of a two-arm rectangular spiral placed on a ground-supported dielectric layer with a permittivity of ϵr = 10.2 and a metallic line surrounding this spiral. Considering the practical implementation, in the proposed TARS-MIA, a superstrate of the same material is used to prevent contact between the tissue and the metallic radiator element. The TARS-MIA has a compact size of 10 × 10 × 2.56 mm3 and is excited by a 50 Ω coaxial feed line. The impedance bandwidth of the TARS-MIA is from 2.39 to 2.51 GHz considering a 50 Ω system, and has a directional radiation pattern with directivity of 3.18 dBi. Numerical analysis of the proposed microstrip antenna design is carried out in an environment with dielectric properties of rat skin (Cole-Cole model ϵf (ω), ρ = 1050 kg/m3) via CST Microwave Studio. The proposed TARS-MIA is fabricated using Rogers 3210 laminate with dielectric permittivity of ϵr = 10.2. The in vitro input reflection coefficient measurements are realized in a rat skin-mimicking liquid reported in the literature. It is observed that the in vitro measurement and simulation results are compatible, except for some inconsistencies due to manufacturing and material tolerances. The novelty of this paper is that the proposed antenna has a unique two-armed square spiral geometry along with a compact size. Moreover, an important contribution of the paper is the consideration of the radiation performance of the proposed antenna design in a realistic homogeneous 3D rat model. Ultimately, the proposed TARS-MIA may be a good alternative for ISM-band biosensing operations with its miniature size and acceptable radiation performance compared to its counterparts.

Face comparison analysis of patients with orthognathic surgery treatment using cloud computing-based face recognition application programming interfaces.

INTRODUCTION: This study aimed to investigate whether the postoperative change in patients after orthognathic surgery, whose facial aesthetics was affected, led to detectable differences using Microsoft Azure, Amazon Web Services Rekognition, and Face++, which were commercially available face recognition systems. METHODS: Photographs of 35 patients after orthognathic surgery were analyzed using 3 well-known cloud computing-based facial recognition application programming interfaces to compute similarity scores between preoperative and postoperative photographs. The preoperative, relaxed, smiling, profile, and semiprofile photographs of the patients were compared separately to validate the relevant application programming interfaces. Patient characteristics and type of surgery were recorded for statistical analysis. Kruskal-Wallis rank sum tests were performed to analyze the relationship between patient characteristics and similarity scores. Multiple-comparison Wilcoxon rank sum tests were performed on the statistically significant characteristics. RESULTS: The similarity scores in the Face++ program were lower than those in the Microsoft Azure and Amazon Web Services Rekognition. In addition, the similarity scores were higher in smiling photographs. A statistically significant difference was found in similarity scores between relaxed and smiling photographs according to different programs (P <0.05). For all 3 facial recognition programs, comparable similarity scores were found in all photographs taken before and after surgery across sex, type of surgery, and type of surgical approach. The type of surgery and surgical approach, sex, and amount of surgical movement did not significantly affect similarity scores in any facial recognition programs (P >0.05). CONCLUSIONS: The similarity scores between the photographs before and after orthognathic surgery were high, suggesting that the software algorithms might value measurements on the basis of upper-face landmarks more than lower-face measurements.

Efficacy comparison of oral rosuvastatin versus oral progesterone and bevacizumab on regression of surgically endometriotic implants in rats.

This study hypothesizes that oral rosuvastatin, oral dienogest and intraperitoneal bevacizumab might improve endometriosis in randomly selected female Wistar albino rats with surgically endometriotic implants. Thirty female Wistar albino rats with surgically endometriotic implants were randomized into three treatment groups: oral rosuvastatin (20 mg kg/day; oral rosuvastatin group 1; n = 10), oral progesterone (dienogest group 2; n = 10) and intraperitoneal bevacizumab (2.5 mg/kg of single intraperitoneal injection of bevacizumab; bevacizumab group 3; n = 10), for 10 days. Post-treatment variables were compared. The oral rosuvastatin group showed higher reduction for the glandular epithelium and uterine vessels of histopathological scores values than the oral progesterone group (both, p < 0.017, respectively). The median glandular epithelium and uterine vessels and histopathological scores values did not show a statistically significant difference between group 1 and group 3 (p > 0.017). Endometrial thickness values and uterine volume values were more significantly reduced in the oral rosuvastatin group than the oral progesterone group (both, p < 0.017, respectively). Moreover, endometrial thickness and uterine volume values were not different in groups wecompared with group 3 (p > 0.017). In conclusion, oral rosuvastatin and intraperitoneal injection of bevacizumab may cause more significant regression of surgically endometriotic implants in rats than oral progesterone medications.

Can the suburethral mesh angle be used to predict trans-obturator tape results?

ABSRACT: PURPOSE: The primary aim of our study was to evaluate mesh movement on ultrasonography and to compare the relationship between suburethral mesh angle and incontinence recurrence. METHODS: This study was carried out at the University of Selcuk, Konya, Turkey, Beyhekim State Hospital, Konya, Turkey and the Mus State Hospital between September 2012 and January 2015. In total, the results from 109 patients were evaluated in the statistical analysis. The suburethral mesh angle (SMA) is the angle between the two arms of the trans-obturator tape (TOT) mesh under the urethra. This angle was measured at 10 days, 6 months and 1 year after surgery. Potential risk factors for incontinence recurrence and SMA were compared in logistic regression models. The best cut-off value for SMA was calculated to predict incontinence recurrence. RESULTS: The mean resting SMA did not change with time during follow-up (p = 0.373). However, when comparing coughing SMA values, the first day measurement was significantly different from the other measurements. Another comparison was performed according to the cSMA value at each visit. The difference was significant from the first day. Lung disease and the change in the SMA (cSMA) on day 10 were significant predictors of treatment failure. The cSMA on day 10 to predict first-year treatment failure was 10°, with 61% sensitivity and 96% specificity. CONCLUSIONS: Measurement of the SMA can be used as a prognostic factor in TOT surgery. Further research is required to determine the importance of SMA as a prognostic factor.

Management of intra-abdominally translocated contraceptive devices, is surgery the only way to treat this problem?

This study was a multi-centre retrospective review of patients with uterine perforation caused by intrauterine contraceptive devices (IUDs). A total of 15 patients were registered, in a seven year period. Among them, five were asymptomatic and the rest were symptomatic. Asymptomatic patients were managed conservatively, except in one case in which the patient requested surgery because she also wanted a tubal ligation. Symptomatic patients all underwent surgery. All the surgeries were elective and all the surgical procedures were initiated laparoscopically. There were seven complications in the surgically managed group: conversion to laparotomy (n = 3), bowel injury (n = 2), bladder injury (n = 1), and wound infection (n = 1). Mild and severe adhesions (81.8%), and abscess (18.1%) formation related to translocated IUD (TIUD) were observed during surgery. All the patients were uneventful at 1 to 5 years of follow-up. A TIUD, by causing adhesions, complicates future laparoscopic surgery and increases the likelihood of conversion to laparotomy. While surgery is indicated to prevent TIUD-induced adhesive complications, it may also be the cause of both adhesions and complications, resulting in a vicious cycle. Some asymptomatic women, especially elderly patients with comorbidities, may not need or may be better managed without treatment. Impact statement In this study we try to find an answer for the question of "Should removal of a translocated intrauterine contraceptive device (TIUD) routinely be performed even if patients are asymptomatic?" From only the theoretical point of view there were some reports supporting conservative management in asymptomatic patients. The other studies addressing this issue were case reports including few patients with a short-term follow-up. The novelties of the present study include multi-centre design, detailed clinical and surgical information about the patients and the long period of follow-up. Most clinicians have limited experiences in managing TIUD because perforation is a rare event. So it can be difficult to know exactly what the surgeon will encounter intraoperatively. We undertook this study with the aim of providing a perspective about patients with TIUD for those faced with this situation. This is a descriptive study reporting 15 cases of TIUDs and management. Asymptomatic patients were managed conservatively, and symptomatic patients were operated. There are important implications resulting from this study that in asymptomatic patients leaving the IUD in place may be a reasonable option, mostly as the risk of surgical intervention is quite high with a high rate of complications with surgical management.

Diagnostic Value of Visual Examination of Cervical Polypoid Lesions and Predictors of Misdiagnosis.

OBJECTIVES: This study reviews occasions when cervical polyps removed in an outpatient setting proved not to be cervical polyps histologically. We aimed to identify any anatomical and/or clinical characteristics that predict 'incorrect diagnosis" in general practice. METHODS: A retrospective study of consecutive 345 patients who were initially diagnosed with cervical polyps based on a routine gynecological examination in an outpatient setting was included. After histopathological examination, the patients were divided into 2 groups: those with cervical (correct diagnosis, n = 307) and falsely diagnosed with cervical polyps (FDP, n = 38). These 2 groups were compared in terms of age, signs and symptoms, and size of the polypoid lesions. RESULTS: The initial clinical diagnosis was correct in 307, giving a positive predictive value of 89%. There were no significant difference between the groups with respect to age of patients (p = 0.59) and the size of the lesions (p = 0.42). According to our study, among misdiagnosed patients, nabothian cysts and cervicitis were the most common histological findings; FDPs were more often symptomatic (p < 0.001) and coexisted more frequently with inflammation or ulceration (p < 0.001). All FDPs were developing within the endocervical canal. There were no instances of FDPs that arise from ectocervix. Symptomatic polypoids have a higher risk of preliminary misdiagnosis (OR = 13.0; 95% confidence interval, 3.0-55.1). CONCLUSIONS: All cervical polypoid lesions must be sent to pathology because visual diagnosis is not sufficiently accurate to direct patient care.

[Relation between mean platelet volume and subclinical atherosclerosis in patients with metabolic syndrome]. / Metabolik sendromlu hastalarda ortalama trombosit hacminin subklinik ateroskleroz ile iliskisi.

OBJECTIVES: Metabolic syndrome (MetS) is associated with increased cardiovascular morbidity and mortality. There is evidence of platelet activation in MetS. Mean platelet volume (MPV), a determinant of platelet activation, is a newly emerging risk factor for atherothrombosis. Therefore, we investigated the possible association between subclinical atherosclerosis, as evaluated by carotid intima-media thickness (CIMT) measurement and MPV, in MetS patients. STUDY DESIGN: Seventy-four patients with MetS were enrolled in the study. Patients were divided into two groups according to CIMT measurement: 35 patients with CIMT >=1.0 mm were in Group 1 and 39 patients with CIMT <1.0 mm were in Group 2. MPV was measured using an automated blood cell counter. RESULTS: The MPV level was significantly higher in patients with CIMT >=1.0 mm than in patients with CIMT <1.0 mm (8.2±0.7 vs. 7.8±0.6 fl; p=0.01). In our study, we observed that platelet count was lower in KIMK >=1.0 mm group and this finding was also found to be statistically significant. CONCLUSION: The risk of atherosclerosis could be shown by following the MPV values in MetS patients. Therefore, our results suggest that MPV is an important marker for early detection of atherosclerotic risk in patients with MetS.

Comparison of robotic-assisted laparoscopic myomectomy outcomes with laparoscopic myomectomy.

PURPOSE: This study aimed at comparing short-term outcomes of patients who underwent robotic-assisted laparoscopic myomectomy and laparoscopic myomectomy. METHODS: From January 2008 to August 2010, prospective data including 15 consecutive patients who underwent robotic-assisted myomectomy (RALM) with the da Vinci surgical system were recorded. These cases were compared with a retrospective cohort of 23 patients who underwent laparoscopic myomectomy (LM). Patient demographics, fibroid characteristics and peri-operative data (operative time, anesthesia time, set-up time, console time for robotic cohort, Estimated blood loss (EBL), length of hospital stay, conversion to laparotomy and operative complications were collected in both groups. RESULTS: Mean operative time for the robotic group was 138.73 ± 39.51 min compared with 140.57 ± 38.17 min for the laparoscopy group (p = 0.887). No significant differences were noted between RALM versus LM for hospital stay (1.67 ± 0.58 vs. 1.87 ± 0.67 days, p = 0.369) and EBL (101.33 ± 39.84 vs. 119.78 ± 43.70 ml, p = 0.549). The numbers, size and location of myomas removed for two groups were similar. None of the cases in both groups required conversion to laparotomy. There were no significant intra-operative and post-operative complications in either group. CONCLUSION: RALM appears to provide the same surgical outcomes when compared with traditional laparoscopic myomectomy.

Removal of amoxicillin via chromatographic monolithic columns: comparison between batch and continuous fixed bed.

This study presented a hydrophobic interaction-based poly(HEMA-MATrp) monolithic chromatographic column (MCC) to remove amoxicillin from aqueous solutions. In addition to their porous structure, monolithic-filled columns offer superior properties without loss of performance, which is one of the points that make them unique. The specific surface area of the monolithic column synthesized by the bulk polymerization of 2-hydroxyethyl methacrylate and N-Methacryloyl-L-tryptophan. Also, poly(HEMA-MATrp) MCC has been characterized via FTIR, SEM, and elemental analysis. According to BET analysis, the specific surface area of the poly(HEMA-MATrp) monolithic chromatographic column (MCC) is 14.2 mg/g. The adsorption and desorption of amoxicillin in an aqueous solution were investigated comparatively in both continuous fixed bed and batch adsorption. The highest adsorption value of amoxicillin was determined at pH 7 in the presence of PBS as 62.11 mg/g. The appropriate adsorption isotherm for the adsorption of amoxicillin was Langmuir, and the reaction kinetics was pseudo-second-order. No significant loss was observed for the adsorption capacity of poly(HEMA-MATrp) MCC after the 5 cycles of adsorption-desorption studies. Also, the loss for the adsorption capacity of the monolithic column is just %5.2 after 6-month storage, proving the reusability and storability of the monolithic column.

Facial recognition by cloud-based APIs following surgically assisted rapid maxillary expansion.

INTRODUCTION: This study aimed to investigate whether the facial soft tissue changes of individuals who had undergone surgically assisted rapid maxillary expansion (SARME) would be detected by three different well-known facial biometric recognition applications. METHODS: To calculate similarity scores, the pre- and postsurgical photographs of 22 patients who had undergone SARME treatment were examined using three prominent cloud computing-based facial recognition application programming interfaces (APIs): AWS Rekognition (Amazon Web Services, Seattle, WA, USA), Microsoft Azure Cognitive (Microsoft, Redmond, WA, USA), and Face++ (Megvii, Beijing, China). The pre- and post-SARME photographs of the patients (relaxed, smiling, profile, and semiprofile) were used to calculate similarity scores using the APIs. Friedman's two-way analysis of variance and the Wilcoxon signed-rank test were used to compare the similarity scores obtained from the photographs of the different aspects of the face before and after surgery using the different programs. The relationship between measurements on lateral and posteroanterior cephalograms and the similarity scores was evaluated using the Spearman rank correlation. RESULTS: The similarity scores were found to be lower with the Face++ program. When looking at the photo types, it was observed that the similarity scores were higher in the smiling photos. A statistically significant difference in the similarity scores (P < 0.05) was found between the relaxed and smiling photographs using the different programs. The correlation between the cephalometric and posteroanterior measurements and the similarity scores was not significant (P > 0.05). CONCLUSION: SARME treatment caused a significant change in the similarity scores calculated with the help of three different facial recognition programs. The highest similarity scores were found in the smiling photographs, whereas the lowest scores were found in the profile photographs.

A prospective study of rollerball endometrial ablation in the management of refractory recurrent symptomatic endometrial hyperplasia without atypia.

BACKGROUNDS: Menorrhagia - heavy, extended or irregular menstruations - may be associated with endometrial hyperplasia. The aim of this study was to evaluate the clinical efficacy and safety of transcervical rollerball endometrial ablation (EA-R) and to discuss surgical outcomes in patients with simple endometrial hyperplasia without atypia who have had a history of medical treatment failure or recurrence. METHODS: A prospective study was designed. Thirty women underwent EA-R. Preoperative and postoperative menstrual status, sexual activity, and satisfaction with the procedure were assessed. Complications, clinical outcomes, and need for re-intervention were evaluated. RESULTS: No major complications occurred. All patients were discharged from hospital within 24 h. A reduction of menorrhagia was observed in patients as follows: 17 patients (56.67%) had amenorrhea, 10 (33.33%) hypomenorrhea, and 2 (6.67%) eumenorrhea. Hysterectomy was performed only in 1 patient who was unresponsive to ablation treatment. CONCLUSIONS: In selected patients who have persistent uterine bleeding not responsive to conservative therapy, low risk for future endometrial cancer, and wish to retain their uterus, EA-R treatment is safe, effective, and might be an alternative to hysterectomy with good toleration and high rate of patient satisfaction. The advantages of EA-R include low incidence of complications, lower morbidity, shorter hospitalization, and faster recovery.

Robotic-assisted sacrocolpopexy/sacrocervicopexy repair of pelvic organ prolapse: initial experience.

PURPOSE: To present the short-term surgical outcomes of robotic-assisted sacrocolpopexy and sacrocervicopexy. METHODS: Between January 2009 and September 2010, 12 patients underwent robotic-assisted pelvic organ prolapse repair including six sacrocolpopexy and six sacrocervicopexy. Patients' demographics, surgical procedures, operative and postoperative complications, hospital stay, conversion to laparotomy, time data including all operative times and estimated blood loss (EBL) were recorded. RESULTS: All surgeries were completed robotically with no conversion to laparotomy. The average operative time for the robotic-assisted sacrocolpopexy (RASCP) was 150.5 ± 29.6 min (range 114-189) and the mean console time was calculated as 123.6 ± 34.2 min (range 84-166). The averages of the dissection and the suturation time were 34.8 ± 24.3 min (range 13-72) and 63.3 ± 21.8 min (range 28-95), respectively. The mean length of hospitalization was 2.8 ± 0.7 days (range 2-4) and the mean EBL was calculated as 12.5 ± 4.1 ml (range 10-20). There was one intraoperative complication. The mean age and body mass index of the patients underwent robotic-assisted sacrocervicopexy were 38.1 ± 6.5 years (29-47) and 28.4 ± 5.8 kg/m(2) (18.6-34.4), respectively. The mean operating times were calculated as follows: set-up time was 25.6 ± 4.0 min, docking time was 3 ± 0.8 min, dissection time was 28.6 ± 7.7 min, suturation time was 70.8 ± 10.9 min and console time was 123.1 ± 23.6 min. There were no recurrences during the follow-up period (12 months) in both groups of the patients. CONCLUSION: The use of the robotic system during pelvic organ prolapse repair is feasible, safe and may support the surgeon during dissection and suturing at the level of sacral promontory.

Efficient green photocatalyst of silver-based palladium nanoparticles for methyle orange photodegradation, investigation of lipid peroxidation inhibition, antimicrobial, and antioxidant activity.

Nanotechnology is an interdisciplinary study that has been developing worldwide in recent years and has a serious impact on human life. The fact that the nanoparticles of plant origin are clean, non-toxic, and biocompatible has enabled new fields of study. The Hibiscus sabdariffa (H. sabdariffa) plant has been attracted by scientists because of its impact on health and many other areas. The lipid peroxidation inhibiting activity, antioxidant properties, and antimicrobial properties of H. sabdariffa plant with Ag-Pd metal was ditermined. For the total phenolic component, gallic acid was used as the standard and quarcetin was used for the total flavonoid. The lipid peroxidation inhibition activity of Ag-Pd NPs in ethanol extract was found to be very well compared to the positive control (BHA). The lowest and highest concentrations of DPPH radical scavenging activity were 82.178-97.357%, whereas for BHA these values were found to be 84.142-94.142%. The highest concentration of Ag-Pd NPs at 200 µg/mL the DPPH radical quenching activity was higher than BHA. Ag-Pd NPs showed a good antimicrobial activity against certain pathogenic microorganisms such as Bacillus subtilis, Enterococcus faecalis, Escherichia coli, Pseudomonas aeruginosa, Candida albicans, which are the causative agents of various diseases in humans. The photodegradation activity of Ag-Pd NPs also investigated against Methyl orange dye (MO) under sunlight irradiation for 120 min and was found to be as 67.88.

Effect of Closure of Anterior Abdominal Wall Layers on Early Postoperative Findings at Cesarean Section: A Prospective Cross-sectional Study.

OBJECTIVE: To investigate the effect of closure types of the anterior abdominal wall layers in cesarean section (CS) surgery on early postoperative findings. METHODS: The present study was designed as a prospective cross-sectional study and was conducted at a university hospital between October 2018 and February 2019. A total of 180 patients who underwent CS for various reasons were enrolled in the study. Each patient was randomly assigned to one of three groups: Both parietal peritoneum and rectus abdominis muscle left open (group 1), parietal peritoneum closure only (group 2), and closure of the parietal peritoneum and reapproximation of rectus muscle (group 3). All patients were compared in terms of postoperative pain scores (while lying down and during mobilization), analgesia requirement, and return of bowel motility. RESULTS: The postoperative pain scores were similar at the 2nd, 6th, 12th, and 18th hours while lying down. During mobilization, the postoperative pain scores at 6 and 12 hours were significantly higher in group 2 than in group 3. Diclofenac use was significantly higher in patients in group 1 than in those in group 2. Meperidine requirements were similar among the groups. There was no difference between the groups' first flatus and stool passage times. CONCLUSION: In the group with only parietal peritoneum closure, the pain scores at the 6th and 12th hours were higher. Rectus abdominis muscle reapproximations were found not to increase the pain score. The closure of the anterior abdominal wall had no effect on the return of bowel motility.

Turkey's experience of robotic-assisted laparoscopic hysterectomy: a series of 25 consecutive cases.

PURPOSE: To present the outcomes of the first 25 robotic-assisted hysterectomies from Turkey. METHOD: A total of 25 patients who underwent robotic-assisted hysterectomy (RAH) for benign conditions were included in the study. Patients' demographics, surgical procedures, operative and postoperative complications, hospital stay, conversion to laparotomy, time data including all operative times, uterus weight and estimated blood loss (EBL) were recorded. All hysterectomies were American Association of Gynecologic Laparoscopists type IVE. RESULTS: All hysterectomies were completed robotically with no conversion to laparotomy. The mean and range of the operating time were 104.1 and 47-176 min, respectively. The mean hysterectomy time was 40.5 min (range 14-77). The mean cuff incision time and cuff suturation time were 6.8 min (range 2-18) and 16.4 min (range 7-40), respectively. The mean set-up time was 30.4 min (range 17-41 min). The mean docking time was 4.3 min (range 2-9 min). The mean console time was 74.2 min (range 30-137). The mean and range of the anesthesia time were 133.8 min and 75-210 min, respectively. The averages of EBL and uterus weight were calculated as 38.2 cc and 221.9 g, respectively. Three complications occurred: one postoperative paralytic ileus and the others were peroperative vaginal cuff lacerations during the removal of the specimen through the vagina. CONCLUSION: Robotic-assisted hysterectomy (RAH) is feasible and safe for women with benign uterine pathologies, although it has limitations that may be overcome in the future.

Comparison of robotic-assisted surgery outcomes with laparotomy for endometrial cancer staging in Turkey.

PURPOSE: To compare the results of patients on whom staging was applied by robotic-assisted laparoscopic surgery and laparotomy for endometrial cancer. METHOD: The study included 10 patients who had undergone robotic-assisted endometrial staging (group 1) and 12 patients staged by open surgery (group 2). Demographical characteristics and operative outcomes of all patients were compared. Body mass index, age, previous abdominal surgeries, histopathologic characteristics, performed operative procedure, operation time, complications, hospitalization duration, estimated blood loss and number of resected lymph nodes were recorded for all patients. RESULTS: Mean age of the patients in the robotic surgery group was 55.7 years (37-66) and in the laparotomy group 56.4 years (47-75). Body mass index was calculated as 32.7 kg/m² (24.5-40.3) in group 1 and 30.3 kg/m² (25.9-35.8) in group 2. Total duration of operation was 234.6 min (137-300) and 168.5 min (102-232) in group 1 and 2, respectively. Mean duration of hospitalization in group 1 was 2.8 days (2-5) and in group 2 was 8.8 days (6-13). Estimates of blood loss were 95 ml (20-210 ml) in the robotic surgery group and 255 ml (80-420) in the other group. The mean number of resected lymph nodes was 42 (13-86) and 46.5 (26-107) in the robotic-assisted surgery group and laparotomy group, respectively. None of the cases in the robotic-assisted endometrial staging group required transition to laparotomy. CONCLUSION: Robotic surgery may be preferred over laparotomy with respect to the advantages observed in the duration of hospitalization, estimated amount of blood loss and complications. There was no significant difference between the two methods in terms of number of resected lymph nodes. Despite the limited number of patients in this study, these results are important as they represent the first data on robotic surgery in Turkey.

Laparoscopy-assisted cystectomy for large adnexal cysts.

OBJECTIVE: To evaluate the feasibility and surgical outcome of laparoscopy-assisted surgery for large adnexal cysts. METHODS: From January 1998 to October 2007, 46 women underwent laparoscopy-assisted surgery for large adnexal cysts whose maximum diameter were between 10 and 20 cm, radiologic and laboratory features suggestive of benign disease. All the patients had a pre-operative ultrasound with or without computed tomography and CA-125 assessment. Patients' demographics, clinical and ultrasound features, CA-125 values, surgical procedures, operative and post-operative complications, estimated amount of blood loss (EBL), operative time, conversion to laparotomy and the pathological findings were recorded. RESULTS: Fourty-six consecutive patients underwent laparoscopy-assisted surgery over 9 years. The mean and range of the patients' age and body mass index were 34.1 +/- 6.3 and (21-45) years and 27.4 +/- 5.9 and (22-40), respectively. In all the patients, except one with borderline ovarian tumor, laparoscopy-assisted surgery was successful. There were no operative or post-operative complications. The mean and range of the operative time, EBL and hospital stay were 48.4 +/- 7.3 and (35-65) min, 55.0 +/- 28.9 and (25-150) mL, 1.49 +/- 0.50 and (1-3) days, respectively. The mean and range of the extracorporeal cystectomy time were 10.2 +/- 2.7 and (8-14) min. The surgical procedures performed were: ovarian and paraovarian cystectomy (n = 45), unilateral salpingo-oophorectomy, pelvic-paraaortic lymphadenectomy and omentectomy (n = 1). Pathologic findings included serous cystadenoma (n = 26), mucinous cystadenoma (n = 7), dermoid (n = 6), endometriosis (n = 6), and borderline ovarian tumor (n = 1). CONCLUSION: Laparoscopy-assisted surgery is feasible and safe for women with large benign adnexal cysts and result s in a short surgery time.