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Aim: This study was to retrospectively evaluate the results of 74 patients who underwent laparoscopic hysterectomy (LH). Methods: The subjects included 74 patients operated in the Department of Obstetrics and Gynecology at Haseki Training and Research Hospital. Total LH were performed for various indications between November 2010 and November 2016. Indications for total LH, method of operation, intraoperative and postoperative complications, duration of the operation, length of hospital stay, and blood loss in patients who underwent total LH were retrospectively evaluated. Results: Seventy four patients were included in our study. The mean age was 47.2±3 years. The mean operation time was 138.4±44 minutes and the mean length of hospital stay was 3.1±1.7 days. The most common indication for LH procedure was abnormal uterine bleeding (25.9%). The average difference between preoperative and postoperative hematocrit values was 4.3%. Major complication rate was 5.3% and minor complication rate was 5.4%. Conclusion: LH is a safe and effective procedure with a low rate of complications in experienced hands in the management of benign gynecological conditions.

Aim The aim of this study was to evaluate the role of suture closure of the subcutaneous tissue in preventing wound complications after cesarean section with a Pfannenstiel incision, and to investigate factors associated with wound complications. Material and Methods Patients undergoing cesarean delivery were randomly assigned to either suture closure or non-closure of the subcutaneous tissue. The participants were invited to two follow-up examinations at the 1st and 4th postoperative weeks for the detection of wound complications. The two main outcomes were composite wound complication and superficial wound separation. Factors associated with wound complications were analyzed using multiple logistic regression. Results During the study period, a total of 361 patients (176 in the closure group, 185 in non-closure group) were analyzed. Composite wound complication occurred in 23.3% (41/176) of the closure group, and in 20% (37/185) of the non-closure group with no significant difference (P = 0.44). Wound separation occurred in 2.3% (4/176) of the closure group and 1.6% (3/185) of the non-closure group without any significant differences (P = 0.64). None of the factors were found to be associated with the rate of composite complication. The significant factors found to be associated with wound separation were subcutaneous tissue thickness of 4 cm or more (P = 0.01) and maternal diabetes mellitus (P = 0.01), however they lost their significance in multivariate analyses. Conclusion The rate of wound complications, including superficial wound separation, did not differ according to the subcutaneous closure in cesarean delivery with Pfannenstiel incision. It is not possible to predict wound complications using previously defined clinical and operative risk factors, including subcutaneous tissue thickness.

Aim: The aim of this study was to compare the surgical procedures for the treatment of stress urinary incontinence and to define which method is more effective and safe. Methods: Records of the patients who were treated for stress urinary incontinence between April 2003 and December 2010 were evaluated. Patients who underwent tension-free vaginal tape (TVT) and transobturator tape (TOT) procedures, and Burch colposuspension were compared for evaluating the efficacy of the operation. Chisquare test and Fischer’s Exact Test were used for categorical variables; continuous variables were analyzed by using student’s t-test. A p value less than 0.05 was considered statistically significant. Results: Follow-up records of 97 patients were analyzed for this study. TVT was the most frequently used anti-incontinence procedure (n=39, 40.2%) followed by TOT (n=34, 35.1%) and Burch (n=24, 24.7%). The mean preoperative and postoperative International Consultation on Modular Questionnaire (ICIQ) scores were 16.4±2.01 and 4.68±5.6, respectively (p=0.0001). There was no significant difference between the operations according to subjective evaluation. The subjective cure/improvement rate for Burch was 87.5%, and was 74.3% and 88.2% for TVT and TOT, respectively. Conclusion: There were no significant differences between Burch, TVT and TOT for long-term efficacy. Surgical procedure should be chosen based on surgical experience and presence of additional surgical procedure. (The Me di cal Bul le tin of Ha se ki 2012; 50: 122-6)

To evaluate the feasibility of ovarian preservation at the time of operation in patients with clinical stage I endometrial carcinoma. The data of 499 consecutive patients with clinical stage 1 endometrial cancer operated between January 2001 and December 2011 were retrospectively reviewed. Clinical and pathologic information and the intraoperative inspection findings of ovaries were evaluated to find the factors associated with the coexisting ovarian malignancy. The mean age of patients was 56.8 ± 9.8 years. Coexisting ovarian tumors were detected in 38 patients (7.6 %), and 28 (5.6 %) of them were malignant (12 metastatic and 16 synchronous primaries). Most of the patients were postmenopausal (n = 371, 74.3 %) and 60 (12 %) of the patients were at the age of 45 years or less. Coexisting malignancy was detected in 9 % (n = 11) of the premenopausal patients and in 5 % (n = 3) of the patients aged 45 years or less. Multivariate analysis revealed that serosal invasion, tubal involvement, and positive abdominal cytology were independent risk factors for coexisting ovarian malignancy. The sensitivity, specificity, positive predictive value and negative predictive value of the intraoperative examination for the diagnosis of benign/normal ovary was 99.6, 78.8, 98.5 and 92.9 %, respectively. The incidence of coexisting ovarian malignancy in clinical stage I endometrial carcinoma is low. Although occult metastasis cannot be excluded at all, careful intraoperative inspection of ovaries seems valuable for the prediction of co-existing ovarian malignancy.

Introduction: Struma ovarii is an ovarian tumor that consists predominantly thyroid tissue and accounts for only 2% of all mature teratomas. It is usually a benign condition - malignant transformation has been reported to occur in about 5% of all struma ovarii cases. Case: A 58-year-old postmenopausal woman attended our outpatient clinic for her annual gynecologic exam, on which a palpable ovary was incidentally found. Ultrasound and magnetic resonance imaging work-up showed two-centimeter solid mass on the right ovary. Laparoscopic salpingo-oophorectomy was performed; the histology report revealed a focus of thyroid papillary carcinoma in a struma ovarii. The patient underwent surgical staging procedure according to the ovarian cancer guideline. The tumor was in stage 1A, thus, no further treatment was indicated apart from follow-up. Conclusion: Malignant struma ovarii is a rare neoplasm of the ovary. Surgical staging should be included in the treatment, like in the other germ cell ovarian tumors. (The Medical Bulletin of Haseki 2011;49: 117-9

Cord entanglement is the situation when one or more loops of the umbilical cord encircle any part of the body. Cord complications may result in fetal demise in the third trimester. However, they are not known to be etiologic factors for missed abortion, in spite of the high ratio of cord entanglement during the first half of pregnancy. We present a case of intrauterine fetal death at 15 weeks’ gestation due to cord entanglement. When the fetus was delivered, an abnormally long umbilical cord for this gestational age was realized (30 cm). The cord passed above the right shoulder of the fetus, and encircled the neck completely and tightly. Then the cord passed through the left axilla towards the placenta. Macroscopically there was no fetal abnormality. Postmortem pathological examination proved the absence of any structural malformations. The most possible cause of intrauterine death was the nuchal cord obstructing blood flow through the umbilical cord.

The objective of this study is to describe a novel technique for the treatment of postpartum hemorrhage and evaluate its effectiveness and safety.Single square hemostatic suture was performed for uterine atony when postpartum hemorrhage did not respond to medical therapy and bilateral uterine artery ligation. We retrospectively reviewed the data of 11 women and evaluated their endometrial cavity with hydrosonography after a follow-up period of 8-34 months.The single square hemostatic suture successfully stopped bleeding in all of the cases. Of the 11 women, 2 could not be traced. Menstruation started without delay in nine women. One of the women achieved pregnancy 25 months after surgery. The six women who underwent hydrosonography had an intact endometrial cavity.For women who desire future fertility, and when bilateral uterine artery ligation is not sufficient to control PPH, single square suturing may be used as an effective and safe procedure.