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Purpose: This systematic review aims to comprehensively assess the safety and efficacy of transvaginal morcellation within an enclosed bag in gynecological surgeries, with a focus on its benefits, potential risks, and recommendations for its use. Methods: We conducted a comprehensive search of Epistemonikos, Web of Science, Medline (PubMed), Scopus, and Cochrane databases for studies on transvaginal contained morcellation in adult patients undergoing gynecological surgeries. The review included 22 studies that met the inclusion criteria, encompassing diverse surgical procedures, patient profiles, and outcomes. These studies were thoroughly reviewed and analyzed to assess the safety and efficacy of the morcellation technique. Results: Key findings from the selected studies indicate that transvaginal morcellation within an enclosed bag offers several advantages in gynecological surgeries, including reduced invasiveness, shorter operative times, and minimal blood loss when compared to conventional methods. The risk of tumor recurrence or dissemination appears to be low when appropriate precautions are taken, emphasizing the technique's safety, especially when performed by experienced surgical teams. While some studies reported complications, these were generally not directly associated with the morcellation technique. Conclusion: Transvaginal morcellation within an enclosed bag demonstrates potential as a safe and effective option for gynecological surgeries. The technique offers the benefits of minimally invasive procedures, including reduced bleeding, shorter recovery times, and improved cosmetic outcomes. This review also highlights the need for standardization in study methodologies and reporting, as the heterogeneity in outcomes across the selected studies poses challenges in drawing definitive conclusions. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to assess the effects of preemptive and preclosure analgesia on postoperative pain intensity in patients undergoing different levels of laparoscopic surgery.Methods: Two hundred and twenty-six patients who underwent laparoscopic gynecological surgery were enrolled in this quasi-randomized, prospective, placebo controlled study. The operations were classified as level 1 or level 2 according to the extent of the surgery. Lidocaine 1 % was administered at the port sites before making the incision in the preincisional study group. In preincisional control group, same amount of saline was infiltrated in same manner. Lidocaine 1 % was infiltrated at the port site immediately after removing the trocars in preclosure study group. In preclosure control group, the same amount of saline was infiltrated in the same manner. Postoperative pain intensity was evaluated by linear visual analogue scale.Results: It was found that preclosure lidocaine infiltration was more effective on postoperative pain intensity than its placebo group in level 1 and level 2 surgery groups at 1 and 2 h postoperatively. The administration of preincisional lidocaine improved postoperative pain scores significantly more than its placebo group in level 1 laparoscopic surgery group at 1 and 2 h postoperatively and in level 2 laparoscopic surgery group at 1 h postoperatively.Conclusion: Lidocaine infiltration at port sites had beneficial effects on pain intensity in the early postoperative period after laparoscopic gynecological surgery. However, the results of present study showed that the analgesic effect mechanism of local anesthetic was unrelated to the preemptive analgesia hypothesis. [ABSTRACT FROM AUTHOR]

Objective: To compare the diagnostic accuracy of endocervical curettage (ECC) and endocervical brushing (EB) in patients referred for colposcopic evaluation for low grade squamous intraepithelial lesion. Materials and methods: A prospective, randomized, comparative trial was conducted in an Education and Research Hospital, Gynecologic Oncology Clinic. After exclusion of 40 subjects, 208 patients were randomly allocated into ECC ( n = 104) and EB ( n = 104) groups. A pathologist blinded to the specimen obtaining method evaluated all samples for the primary outcome of sampling adequacy. Secondary outcome measure was pain scores during the sampling was investigated by using visual analogue scale (VAS). Results: Ten samples from the ECC group (9.6 %) and 12 samples from the brushing group (12 %) contained scanty endocervical specimen ( p = 0.09). Evaluating samples for stroma; it was reported that brushing group had a statistically significantly higher percentage of specimens with no stroma (44 %) than ECC group (24 %) ( p = 0.003). Mean and standard deviation of VAS scores during the ECC and EB procedures were 2.55 ± 1.12 and 1.99 ± 0.87, respectively ( p < 0.001). Conclusion: Endocervical brushing was proved to be as accurate with respect to diagnostic yield as ECC but less painful, evaluating the endocervical canal. It can be an alternative for evaluation of the cervical canal pathology in patients with low grade cytologic abnormalities but devoid of the misinterpretation of stromal invasion; ECC should be preferred in patients with a suspicion of invasive disease. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy of metformin and clomiphene citrate (CC) therapies for ovulation induction in anovulatory infertile women with polycystic ovary syndrome (PCOS). Methods: A total of 69 consecutive infertile, anovulatory women with PCOS were enrolled in this prospective, non-randomized trial. The women were prescribed either 1,700 mg/day metformin or CC with a starting dose of 50 mg/day up to 150 mg/day for a period of six consecutive cycles. Results: Metformin and CC groups were followed for a total of 136 and 94 cycles, respectively. Metformin group had lower rates of ovulation when compared with CC group (32.3 vs. 60.6%, respectively; p = 0.004). There was no statistical difference in pregnancy rates per cycle between the treatment groups (8 vs. 11.7%, respectively; p = 0.33) leading to similar cumulative pregnancy rates (36.6 vs. 35.4%, respectively; p = 0.45). No difference was observed among the abortion rates (10 vs. 10%, respectively; p > 0.05) between the groups. Discussion: Although metformin and CC are two effective first-line approaches for improving pregnancy rates in anovulatory PCOS women, CC is associated with higher rates of ovulation. [ABSTRACT FROM AUTHOR]

Objective: The value of genetic sonogram is controversial in low-risk population. The aim of our study was to compare the anxiety levels among women with high risk and low risk for fetal chromosomal/structural defects. Materials and Methods: A total of 115 consecutive pregnant women were included. The anxiety levels were assessed by the use of Turkish version of the standardized state-trait-anxiety-inventory. Before and after genetic sonogram, state and trait-anxiety was measured. Results: The mean state anxiety score before genetic sonogram was statistically, significantly higher than the mean score after the examination. Before genetic sonogram, the mean state-anxiety score of the women with high risk for fetal chromosomal/structural defects was significantly higher than the mean score of women with low risk. Following genetic sonogram, although the anxiety scores decreased, the scores of women with high risk still remained significantly higher than the scores of women with low risk and the anxiety scores significantly further increased among women with a positive minor or major ultrasound finding. Conclusion: Genetic sonogram presents an anxiety-inducing situation for the parents-to-be. The level of experienced anxiety was found to be proportional to the level of the perceived risk. Women with low risk for chromosomal/structural defects experienced lower anxiety than women with high risk. Following the examination, women with a negative result were found to have a significant reduction of anxiety and emotional relief whereas a positive test result led to a further increase in anxiety scores. [ABSTRACT FROM AUTHOR]

The aim of the present study was to measure the treatment of menorrhagia and health-related quality of life (QoL) in Levonorgestrel-releasing intrauterine system (LNG-IUS) in Turkish women. We recruited 66 premenopausal women, aged 26–55 years, who had sought care in the previous year for menorrhagia. All patients were asked to complete a visual analog scale (VAS) form regarding pelvic pain, sexual life (libido) and general feeling of health. Patients filled the VAS form before LNG-IUS insertion and after 6 months. After the 6-month visit, PBAC score was condirebly decreased ( p < 0.001). Six (10%) of the 60 patients PBAC score was higher than 75. VAS score for pelvic pain decreased from baseline to 6-month follow-up (4.32–3.55), and the libido and general feeling of health increased (4.27–4.95 and 3.47–6.87, respectively). The LNG-IUS device in the trearment of menorrhagia has cost effective, less side effects and increse in the QoL. [ABSTRACT FROM AUTHOR]

The aim of the study was to evaluate the interobserver variability of modified Ferriman–Gallwey (mFG) hirsutism scores on each body area in a Turkish population. A cross-sectional study of simultaneous mFG scoring design was used. Observers did not make any interview with the subjects and were masked to the previous score results. Analyses included percentage of agreement, kappa coefficients, the Bland and Altman plot, confidence intervals, minimum and maximum kappa coefficients. The study was performed at a teaching and research hospital. Hundred and twenty-one Turkish women without any complaints of excessive body hair were studied. Interventions included two special trained physicians, simultaneous and independent mFG scoring. The main outcome measures were mFG scores in each body area. Agreement analysis demonstrated that the scores of the two physicians were quite concordant. The mean kappa value for nine body area was 0.744 and the highest kappa values from the upper back and the lowest kappa values from the upper lip revealed к = 0.847, к = 0.585, respectively. The highest (upper lip) and the lowest (arm) mean range scores for the two researchers among the 9 areas were 1.46–1.55 and 0.17–0.12, respectively. Only 68.6 and 67.8% of the mFG scores observed by each of the two observers were equal or below 8. The mFG scoring system was found to be clinically useful. The upper lip was observed to have the highest score of androgen sensitive area of the body as well as the highest interobserver variability. The cut-off value to establish the diagnosis of hirsutism should be population-specific. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 31-year-old woman with 12 years primary infertility and a history of pulmonary tuberculosis for 15 years. She was diagnosed with pulmonary tuberculosis and was given antituberculosis therapy. She was also diagnosed of bilateral tubal occlusion and an in vitro fertilization (IVF) cycle had been attempted. It also discusses her history of having unilateral laparoscopic salpingectomy because of an ectopic pregnancy after her IVF cycle.

A letter to the editor is presented in response to the article "Use of uterine fundal pressure maneuver at vaginal delivery and risk of severe perineal laceration," by K. Matsuo and colleagues in the October 16, 2009.