Progesterone receptor B over progesterone receptor A prevents recurrence in bilateral endometriomas.

OBJECTIVE: Endometriosis is a disease in which stromal cells and endometrial glands extend outside of the uterine cavity. Nevertheless, treatment failure and recurrence cause difficulties in management. This study aimed to evaluate the receptor-level components of bilateral endometriomas in the recurrence state. METHODS: Our retrospective cohort study was conducted with patients who underwent surgery for bilateral endometriomas between 2015 and 2021. In total, 113 patients were allocated. A total of 76 patients did not meet the eligibility criteria, and the data of 37 patients were evaluated. Medical treatments, recurrences, and postoperative follow-up data were collected. In archived tissue samples, measurements of progesterone receptor A and progesterone receptor B, histoscores and immunoreactivity scores, and their ratios were calculated in the group that received no postoperative medical treatment. Criteria for recurrence were a repeat operation and/or the detection of a new endometrioma>2 cm at the follow-up examination. RESULTS: No recurrence was observed in 73.0% (n=27) of the cases, whereas recurrence was observed in 27.0% (n=10) of the participants. Patients without recurrence had significantly higher progesterone receptor B histoscore/progesterone receptor A histoscore and progesterone receptor B immunoreactivity score/progesterone receptor A immunoreactivity score results (p=0.01). Nevertheless, when the histoscores and immunoreactivity scores for both receptors were contrasted separately, there was no appreciable difference between them. CONCLUSION: The dominance of progesterone receptor B over progesterone receptor A was inversely proportional to the recurrence status in bilateral endometriomas. Furthermore, our study revealed that assessing receptor levels alone did not result in a significant difference in recurrence.

Comparison of vNOTES technique with conventional laparoscopy in gynecological emergency cases.

BACKGROUND: Vaginal natural orifice transluminal endoscopic surgery (vNOTES) has emerged as a minimally invasive approach. This study aimed to evaluate the feasibility and surgical outcomes of the vNOTES method and compare it with conventional laparoscopy (CL) in gynecological emergency cases. MATERIAL AND METHODS: A retrospective study was conducted to compare vNOTES with CL regarding pre-/intra-/postoperative outcomes. The women who were operated on for emergency indications such as ectopic pregnancy, ovarian torsion, ovarian cyst rupture and acute abdominal pain were evaluated. Patients' age, gravidity, parity, medical/surgical history, height, weight, blood pressure, heart rate, pre-/postoperative hemoglobin and hematocrit levels, the quantity of aspirated hemoperitoneum, visual analog scale (VAS) pain scores six and 12 h postoperatively, duration of surgery and hospital stay were recorded. RESULTS: The study was conducted with 90 women. Sixty of them underwent CL, while 30 women had vNOTES. The vNOTES group had a significantly shorter duration of surgery -28.5 min (15-48 min) vs. 77 min (29-155 min), respectively, p < .001), shorter hospital stay - 32 h (11-125 h) vs. 38 h (12-201 h), respectively, p = .007), lower VAS scores after 6 h - 5 (4-7) vs. 6 (2-8), respectively, p < .001), and after 12 h - 2 (1-3) vs. 2 (1-5), respectively, p < .001) and a lower dose of postoperative analgesic administration - 2 (2-3) vs. 3 (1-5), respectively, p < .001) than the CL group. CONCLUSION: vNOTES surgeries can be considered an alternative technique to CL by providing shorter surgery duration, lower postoperative pain scores, shorter hospital stays and better cosmetic outcomes.

The Comparison of Surgical Outcomes following Laparoscopic Hysterectomy and vNOTES Hysterectomy in Obese Patients.

AIM: This study aimed to compare the surgical outcomes of total laparoscopic hysterectomy (TLH) and vaginally assisted natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy procedures in obese patients. MATERIALS AND METHODS: This cross-sectional study was conducted with 83 obese women (BMI > 30 kg/m2) who underwent TLH (35 patients) or vNOTES hysterectomy (48 patients) for benign gynecological indications. The duration of surgery, intra/postoperative complications, intra- and postoperative hemoglobin (Hb) and hematocrit (Hct) levels, hospital stay, Visual analogue scale (VAS) scores at the postoperative 6th and 24th hours of the patients were compared. RESULTS: There was no significant difference between TLH and vNOTES groups regarding age (49 vs. 52 years, p = 0.35), parity (2 vs. 3, p = 0.17), and uterine weight (290 vs. 230 g., p = 0.13) The median BMI was 31.6 kg/m2 (30-42.2 kg/m2) in the TLH group and 31.9 kg/m2 (30-54.6 kg/m2) in the vNOTES group (p = 0.31). The vNOTES hysterectomy group had significantly shorter durations of surgery (67.5 vs. 136 min) and postoperative hospitalization than the TLH group (p < 0.05 for all comparisons). Besides, the 6th-hour (6 vs. 7, p = 0.02) and 24th-hour (4 vs. 3, p < 0.001) VAS scores were significantly lower in the vNOTES hysterectomy group. The propensity-matched group analysis showed significantly lower 6th-hour and 24th-hour VAS scores and shorter duration of surgery (80 vs. 135 min, p < 0.001) in the vNOTES hysterectomy group than the TLH group. CONCLUSION: vNOTES is a feasible technique in obese women who require a hysterectomy and provides favorable outcomes considering the shorter duration of surgery and postoperative hospitalization and lower pain scores.