A New and Alternative Route: Transvaginal Natural Orifice Transluminal Endoscopic Scarless Surgery (vaginal natural orifice transluminal endoscopic surgery) For Class 2 and Class 3 Obese Patients Suffering From Benign and Malignant Gynecologic Pathologies.

Background. This study was conducted to investigate the effectiveness of vaginal natural orifice transluminal endoscopic surgery (vNOTES) gynecologic scarless surgery in benign and malignant class 2 and class 3 obese patients. Materials and methods. The class 2 and class 3 obese women undergoing vNOTES scarless surgery for benign and malign indications at a tertiary referral medical center between January 2019 and April 2021 were retrospectively analyzed and surgical outcomes were measured. Results. In this study, 81 class 2 and class 3 obese patients underwent gynecological procedures using vNOTES scarless surgery. Of the 81 operations, 55 of the class 2 obese patients with benign pathologies, and 26 of the class 3 obese patients had malign pathologies. No conversion to conventional laparoscopy or even laparotomy was needed in any of the procedures. All of the surgeries were performed by the same surgeon (Prof. Dr Ahmet Kale). vNOTES scarless surgery was performed on 26 class 3 obese patients with malign pathologies. Of the 26 class 3 obese patients, 22 of the class 3 obese patients with early-stage endometrial carcinoma had very high mean body mass index 41.5 kg/m2 (range 20.6-56) and 4 of the class 3 obese patients had ascites with unknown cause and diagnosed with peritoneal carcinomatosis. The mean postoperative pain VAS scores of class 2 obese patients undergoing vNOTES scarless surgery with benign pathology at 6, 12, and 24 h were 3.19, 1.11, and .66, respectively, and the mean postoperative pain VAS scores of class 3 obese patients underwent vNOTES scarless surgery with malign pathology at 6, 12, and 24 h were 3.30, 1.76, and 1.03, respectively. Conclusion. vNOTES scarless surgery is an alternative surgical method for diagnosis and treatment not only in benign obese cases, but also in severely obese patients with early stage endometrial cancer and patients had with ascites with unknown cause. In the near future, vNOTES scarless surgery will become more preferable by experienced surgeons in benign and malignant obese cases as it has increased satisfaction with esthetic results such as less pain, and improved postoperative quality of life in the short and long term.

Translation, cultural adaptation, and validation and reliability of assessment of pelvic floor disorders and their risk factors during pregnancy and postpartum questionnaire in Turkish population.

OBJECTIVES: This study was conducted in order to produce translation, cultural adaptation, and validation of Assessment of Pelvic Floor Disorders and Their Risk Factors During Pregnancy and Postpartum Questionnaire (APFDQ) to Turkish in pregnant and postpartum population. MATERIAL AND METHODS: The study included 80 pregnant women. Internal consistency was tested using Cronbach's alpha. Questionnaires were applied three different times in order to assess for sensitivity. Patients were asked to complete the questionnaire first in the third trimester, secondly in postpartum 6th week and finally in postpartum 6th month after birth. For translation process content, face/content validity, reliability, construct validity and reactivity studies were done. All women had undergone pelvic examination and prolapse was assessed by using Pelvic organ Prolapse Quantification System (POP-Q). Urinary symptoms were also evaluated with Urinary Distress Inventory (UDI-6) questionnaire. RESULTS: The mean age of patients was 27.7 ± 5.5 years. Forty-one (51.25%) of the patients had vaginal delivery and 39 (48.75%) had a cesarean section. Above 96% of the patients had completed the questionnaires. POP-Q assessments and UDI-6 results were used to evaluate construct validity. Cronbach's alpha results were found to be 0.7 for all the subscales of the questionnaire: bladder: 0.702, bowel: 0.744, prolapse: 0.701, sexual function: 0.706 respectively, indicating adequate reliability. The test/retest reliability was studied and Pabak values showed moderate reliability in the bowel, prolapse and sexuality, and good reliability for bladder subscale. The results of the patients were compared between pregnancy and postpartum to assess reactivity and shown to be reactive to changes. Also risk factors of the patients were assessed including, family predisposition, maternal age over 35 years, BMI > 25, nicotine use, subjective inability to contract pelvic floor and sense of postpartum wound pain. CONCLUSIONS: The Turkish version of APFDQ is a reliable and valid tool. It can be used for assessing the risk factors, incidence, assessing degree of PFDs and evaluating the impact on quality of life in pregnant and postpartum women.