Search

This review aimed to compare isolated sciatic and sacral nerve root endometriosis in terms of anatomic distribution, patients' symptoms and history, diagnostics, treatments, and outcomes.We searched PubMed, MEDLINE, Web of Science, and Embase from inception to October 2021 using a combination of keywords including "sciatic nerve endometriosis," "sacral nerve root endometriosis," and associated Medical Subject Headings. Relevant publications and references were also checked for further articles.Two independent researchers performed the study selection. We included all original research articles, case reports, and case series in English that reported on the isolated sciatic nerve and sacral nerve root endometriosis.The initial search identified 92 articles, and 40 articles, mostly case reports and case series, were included. The review included 362 patients: with 256 and 106 patients in the sacral and the sciatic groups, respectively. In both groups, most patients had right-sided endometriosis. In the sciatic group, most of the patients presented with foot drop, leg motor weakness, and sciatic dermatome hypoesthesia. The frequencies of all these symptoms were significantly higher in the sciatic group (all p.001). By contrast, in the sacral group, most of patients presented with pudendal neuralgia (p.001). Intraoperative, early, late, and 1-year postoperative complications did not differ significantly between the 2 groups.This study indicated that isolated sciatic and sacral nerve root endometrioses were more common on the right side. Laparoscopic surgery was more commonly performed over traditional open or transgluteal surgery techniques. Sacral nerve root endometriosis is often accompanied by deep infiltrating endometriosis. Magnetic resonance imaging and myelography may be useful diagnostic tools in the preoperative workup. There was usually no significant improvement after surgery in cases of isolated sciatic nerve endometriosis presenting with foot drop.

Objective: To investigate the effectiveness of combining side-to-end anastomosis and vaginal NOSE (Natural orifice specimen extraction) surgery in colorectal endometriosis. Material and methods: We included 11 patients treated with laparoscopic side-to-end colorectal anastomosis and vaginal NOSE surgery between January 2019 and May 2021. We questioned the visual analog score (VAS) for pain symptoms, the short form-36 (SF-36) for health survey questionnaire, The Female Sexual Function Index (FSFI), EHP-5 for endometriosis health profile, The Hospital Anxiety and Depression Scale (HADS), OAB-V8 for overactive bladder symptoms and Constipation Severity Instrument (CSI). Results: VAS, EHP-5, and SF-36 scores were better at postoperative third and sixth months than preoperative values ( p Conclusions: Laparoscopic side-to-end anastomosis with vaginal NOSE surgery is feasible, scarless, and could be offered to patients with deep symptomatic bowel endometriosis.

Pudendal neuralgia (PN) is an extremely painful neuropathy of the pudendal nerve resulting in a negative impact on a patient's quality of life. The aim of this study is to evaluate the 2-year outcomes of repetitive doses of the transvaginal pudendal nerve injections (PNI), and to compare the success of the PNI concerning anatomical levels (endopelvic and extrapelvic portion) of the pudendal nerve pathology.This retrospective longitudinal cohort study consists of patients with PN diagnosed with the first four essential Nantes criteria. Diagnostic PNI was performed on 67 patients to fulfill the fifth criteria of Nantes. A total of 56 patients who responded to the initial diagnostic PNI underwent therapeutic repeated transvaginal PNIs twice for 3 weeks apart. Mean pain intensity scores were measured using a visual analog scale at the 1st, 3rd, 6th, 12th, and 24th months after the therapeutic blocks were completed. Effectiveness of the PNIs' was defined as ≥ 50% improvement of the initial pain, and relative improvement was defined as 30-50% improvement of the initial pain. Treatment failure was defined as the reduction of the initial pain by less than 30% or the return of the pain to its worst condition.The efficacy of the PNIs significantly declined over time. Pudendal nerve blocks provided a significant decrease in pain scores; however, this decrease lost its strength significantly in the 24th month. The intervention was more effective in entrapments of the pudendal nerve between sacrospinous and sacrotuberous ligaments or below (Level-2) when compared to the injuries in the endopelvic part (Level-1). More than 50% pain reduction continued in five patients with pathology at Level-1 and 24 patients with pathology at Level-2.Repeated PNIs could provide a significant decrease in pain scores for both short- and long-term periods. However, the efficacy of the PNIs declined over 2 years. The success of PNIs may be affected by the anatomical level of the nerve injury; therefore, interligamentous pudendal nerve entrapment cases have more benefits than the cases of pudendal nerve entrapment in the endopelvic part. However, it is recommended to perform therapeutic nerve blocks even in patients with suspected endopelvic pudendal nerve pathology before the referral to surgery.

Adenomyosis is a benign uterine disorder where endometrial gland and stromal tissue are abnormally located within the myometrium. The common symptoms of adenomyosis are abnormal uterine bleeding (menorrhagia), dysmenorrhea, dyspareunia and infertility. The gold-standard method for treating adenomyosis is hysterectomy. For patients who desire to preserve their uterus, an alternative therapy would be adenomyomectomy which is sparing uterus. Such a procedure may be performed with open surgery or minimally invasive surgery. It is obvious that minimal invasive surgery would be better for the patient’s health. However, there is inadequate evidence to decidedly say which invasive surgery which invasive surgery would be best for the patient. We suggest that one of the newest techniques, robotic surgery is to be preferred an alternative approach for gynecological operations as well as would be an option for uterine surgery. This technique would allow for 3-D visualization and multijoint endowrist movement, which compared to laparoscopy, yields various advantages for surgeons. We therefore recruit seven participants diagnosed with symptomatic adenomyosis who admitted to Endometriosis and Chronic Pelvic Pain Center of Acibadem Altunizade Hospital between March 2019and January 2021 requested to preserve fertility. They all underwent robotic adenomyomectomy. The parameters evaluated herein will be, whether the pain and bleeding scores changed during the postoperative period, amount of blood loss during the operation and the associated decrease in Hg levels. Robotic adenomyomectomy is one of the uterus-sparing adenomyosis surgery methods and is safely applied in selected patients.

Introduction: Piriformis syndrome is an uncommon disease resulting from the piriformis muscle’s compression of the sciatic nerve. Pain and numbness in the buttocks and down the leg are the most common symptoms. This study analyzes the laparoscopic surgical treatment of piriformis syndrome. Methods: We report three cases of piriformis syndrome diagnosed in our hospital. The first case was a 40 years old woman with a 7-year history of intermittent low back pain and sciatica on her right side. Hyperesthesia and cutaneous allodynia were observed in the right sciatic nerve dermatome. The second case was a 30 years old woman with a 2-year history of sciatica on her left side. The third case was a 30 years old woman with a 2-year history of sciatica on her right side. All the patients underwent laparoscopic decompression surgery, which was performed to release the sciatic nerve or sacral nerve roots. Results: The patients were reexamined at the postoperative 3rd and 6th months. Their visual analog scale (VAS) scores were found to be decreased from 10/10, 9/10, and 7/10 to 0/10, 1/10, and 0/10, respectively. Conclusion: Due to the very few cases in the literature, pelvic piriformis syndrome is an exclusively clinical diagnosis. If the sciatica is refractory to conservative treatments, laparoscopic exploration and decompression surgery of the pelvic nerves and piriformis muscle could be an option.

Objective To apply rapid online surveying to determine the knowledge and perceptions of the COVID-19 pandemic on patients with endometriosis in Turkey. Methods An online survey was conducted by the Turkish Endometriosis & Adenomyosis Society and administered to patients with endometriosis who agreed to participate in the study. The survey included 25 questions prepared by an expert committee of four professionals (two gynecologists and two endometriosis specialists). Results Of the 290 questionnaires sent out, 261 (90%) were returned. A total of 213 (83.86%) patients reported that they were afraid of having endometriosis-related problems during the pandemic period. In addition, 133 (53.63%) patients thought the management of their endometriosis was affected because of the pandemic. Conclusion Clinical studies clearly indicate that endometriosis is a condition associated with high levels of chronic stress. The COVID-19 pandemic has led the public to experience psychological problems such as post-traumatic stress disorder, psychological distress, depression, and anxiety. The majority of patients with endometriosis were afraid of having endometriosis-related problems during the pandemic period. The majority of elective endometriosis surgeries have not been postponed. Patients were highly aware of the pandemic and practiced social distancing and hygiene. Only 4 (1.59%) patients with endometriosis required hospitalization.

Aim: Endometriosis is a disease affecting women of fertile age, with an estimated more than 176 million women worldwide suffering from their symptoms, with no correlation between the degree and symptoms of the disease. Although the initial treatment in endometriosis is medical treatment, patients with severe symptoms are candidates for surgery as the last choice. We contribute to the literature by publishing our 15 cases and to discuss surgical treatment methods. Method: Patients operated due to the endometriozis in Kartal Dr Lutfı Kırdar Training and Research Hospital between January, 2019 and January, 2020 were evaluated. 15 patients were found according to the criteria. and discussed according to the literature. All patients’ age, body mass index, gravida, parity, medications, chronic diseases,, past surgical history, duration of diagnosis time, ultrasonograph results, clinical symptoms, physical examinations,surgical procedure, operation time, complications, hospital discharge time, preoperative and postoperative pain scores [10-cm visual analogue scale (VAS)] were analyzed Results: When the postoperative VAS scores were evaluated, it was found that the scores improved significantly compared to preoperative VAS scores. Intraoperatively, ureter damage in one patient and bowel damage in one patient were detected. Wound infection was detected as a postoperative complication in one patient. Conclusion: Operations performed by experienced teams in cases resistant to medical treatment in endometriosis benefit the patient, as well as operations performed by inexperienced hands may harm the patient. Therefore, we think that patients who need endometriosis surgery should be directed to experienced centers.

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.

Purpose: Pudendal neuralgia (PN) is an extremely painful neuropathy of the pudendal nerve resulting in a negative impact on a patient's quality of life. The aim of this study is to evaluate the 2-years outcomes of repetitive doses of the transvaginal pudendal nerve injections (PNI) and to compare the success of the PNI concerning anatomical levels (endopelvic and extrapelvic portion) of the pudendal nerve pathology.Methods: This retrospective longitudinal cohort study consists of patients with PN diagnosed with the first four essential Nantes criteria. Diagnostic PNI was performed on 67 patients to fulfill the fifth criteria of Nantes. After the drop-outs, further analyses were carried out with a total of 56 patients.Results: The efficacy of the PNIs significantly declined over time. Pudendal nerve blocks provided a significant decrease in pain scores; however, this decrease lost its strength significantly in the 24th month. The intervention was more effective in entrapments of the pudendal nerve between sacrospinous and sacrotuberous ligaments or below (Level-2) when compared to the injuries in the endopelvic part (Level-1). More than 50% pain reduction continued in five patients with pathology at Level-1 and 24 patients with pathology at Level-2. Conclusion: Repeated PNIs could provide a significant decrease in pain scores for both short and long-term periods. However, the efficacy of the PNIs declined over two years. The success of PNIs may be affected by the anatomical level of the nerve injury; therefore, interligamentous pudendal nerve entrapment cases have more benefits than the cases of pudendal nerve entrapment in the endopelvic part. However, it is recommended to perform therapeutic nerve blocks even in patients with suspected endopelvic pudendal nerve pathology before the referral to surgery.

Objective This review aimed to categorize thoracic endometriosis syndrome (TES) according to whether the presenting symptoms were catamenial and to evaluate whether such a categorization enables a better management strategy. Data Sources An electronic search was conducted using the PubMed/Medline database. Methods of Study Selection The following keywords were used in combination with the Boolean operators AND OR: “thoracic endometriosis syndrome,” “thoracic endometriosis,” “diaphragm endometriosis,” and “catamenial pneumothorax.” Tabulation, Integration, and Results The initial search yielded 445 articles. Articles in non-English languages, those whose full texts were unavailable, and those that did not present the symptomatology clearly were further excluded. After these exclusions, the review included 240 articles and 480 patients: 61 patients in the noncatamenial group and 419 patients in the catamenial group. The groups differed significantly in presenting symptoms, surgical treatment techniques, and observed localization of endometriotic loci (p Conclusion This review points out the significant differences between patients with TES with catamenial and noncatamenial symptoms. Such categorization and awareness by clinicians of these differences among patients with TES can be helpful in designing a management strategy. When constructing management guidelines, these differences between patients with catamenial and noncatamenial symptoms should be taken into consideration.

Introduction: Retroperitoneal fibrosis (adhesions) in the pelvic area is rare and not well known in gynecology. However, their presence can cause compression neuropathy leading to severe pain symptoms involving the lower extremities. A neuropelveological approach can be applied in dealing with such cases in diagnosis and management. Objective: To demonstrate neurolysis of sacral nerves in patients with retroperitoneal fibrosis (adhesions). Case presentations: Case 1: A 43-year-old gravidity 1 parity 1 female patient with known endometriosis presented with dysmenorrhea, dyspareunia, and left-sided sciatica. Gynecological examination revealed a rectovaginal nodule and full obliteration of pouch of Douglas. Robot-assisted laparoscopic sacral neurolysis and dissection of pouch of Douglas with rectal nodule shaving was performed. The patient was symptom free 6 months postoperatively. Case 2: A 49 years old gravidity 2 parity 2 female patient presented with severe pain on the left groin and leg, dysuria, and constipation, which required frequent manual evacuation of the feces. The begin of her symptoms coincided with a previous laparoscopic total hysterectomy, where she experienced postsurgical hemorrhage. Laparoscopic sacral neurolysis with adhesiolysis was performed. The patient was symptom free 6 months postoperatively. Conclusion: Pelvic retroperitoneal fibrosis (adhesions) are rarely encountered in gynecology. However, they should be included in differential diagnosis in patients presenting with pelvic pain accompanied by lower extremity pain, urinary, and/or bowel symptoms. Since presurgical diagnosis of fibrosis (adhesions) is hard with visualization techniques such as transvaginal ultrasound or magnetic resonance imaging, a thorough neuropelveological examination can be helpful in such cases.

AIM The study objective was to compare intraoperative and early postoperative outcomes among patients who underwent hysterectomy via transvaginal natural orifice transluminal endoscopic surgery (and single-port lararoscopy for presumed benign gynecologic disorders). METHODS We retrospectively reviewed 40 patients who underwent single-port laparoscopic hysterectomy and 20 patients who underwent hysterectomy via natural orifice transluminal endoscopic surgery. Patients' age, body mass index, history of previous delivery and surgery, total operation time (from skin incision to closure), intraoperative and postoperative complications conversion to another surgical procedure, drop of hemoglobin level, postoperative pain at 1 and 18 h, average hospital stay, and clinical outcomes were analyzed. RESULTS Hysterectomy via transvaginal natural orifice transluminal endoscopic surgery was superior to single-port hysterectomy concerning the length of hospitalization (p

Pandemi olarak ilan edilen COVID-19 enfeksiyonu ile ilgili her geçen gün morbidite ve mortalite oranları yükselmektedir. Kaynağı henüz netlik kazanmamış olan virüsün en önemli özelliği hızlı bir şekilde damlacık yoluyla ve temas ortamından insandan insana yayılmasıdır. COVID-19, başta akciğerler olmak üzere beyin, böbrek, karaciğer gibi birçok organı etkileyebilmektedir. Yetişkinlerde klinik tablo soğuk algınlığından bronşit, pnömoni, ağır akut solunum sıkıntısı sendromu ve ölümle sonuçlanan çoklu-organ yetmezliğine kadar değişebilmektedir. Klinik tablonun yanı sıra sosyal, mesleki, ekonomik ve psikolojik olarak da insanları etkilemektedir. Birçok salgında olduğu gibi Covid-19’da da, uygun bakımı verme, doğru müdahalelerde bulunma, gerekli psikososyal desteği sağlama, hasta/hasta yakınlarına eğitim verme, hasta haklarını savunma ve doğru sağlık davranışlarının kazandırmada hemşirelere önemli görevler düşmektedir. Henüz tam aydınlatılamamış olan bu hastalıkta yapılacak tedavi ile birlikte verilecek hemşirelik bakımı, hastanın konforu ve yaşam kalitesi için büyük önem taşımaktadır. Hemşirelik bakımının sistemli ve bilimsel bir yaklaşımla gerçekleştirilebilmesi için hemşirelik modellerine dayandırılması dolayısıyla hemşirelik sürecinin bir hemşirelik modeli ile birlikte kullanılması gerekmektedir. COVİD-19 tanılı bir hastayı Yaşam Aktivitelerine Dayalı Hemşirelik Modeli doğrultusunda değerlendirmek, hemşirelik tanıları, girişimleri ve sonuçları doğrultusunda verilen hasta bakımının; bu hastaların semptom kontrolü, yaşam aktiviteleri, uyumu, konfor ve yaşam kalitesini artırmaya yönelik bakımına katkı sağlayacağı, ayrıca hemşirelik sürecinin kullanımına örnek olacağı düşünülmektedir.

Purpose In December 2019, the COVID‐19 pandemic started in China and spread around the World. Operations were postponed in most surgical clinics to reduce the risk of contamination and increase the number of beds available in hospitals. We investigate whether elective gynaecologic surgery is safe or not under safety measures. Methods A total of 765 patients were operated on electively between 15 March and 30 October 2020 at our inpatient gynaecology clinic. We took the SARS‐CoV‐2 Reverse Transcriptase (RT) Polymerase Chain Reaction (PCR) test of the nasopharyngeal swab before and after the surgery. Patients were questioned for COVID‐19 symptoms by phone calls on the 7th, 15th, 30th and 60th days postoperatively. Results The average age of patients was 45.6 ± 11(19‐81). Sixty‐two (8.1%) operations were performed due to gynaecologic malignancies. Three patients (0.39%) were detected as SARS‐CoV‐2 RT PCR positive within 7 days after surgery. The patients did not need ICU admission or any further treatments. Conclusion Our study offers a novel perspective on elective surgery during a pandemic. The risk assessment of patients should be meticulously done and substantiated on objective variables. According to our study, in a carefully selected patient population, operating under appropriate precautions, elective gynaecologic surgical procedures during the two peaks of the COVID‐19 pandemic do not pose a risk to the patients.

Background: Piriformis syndrome is an uncommon disease result from compression of the sciatic nerve by the piriformis muscle. Symptoms may include pain and numbness in the buttocks and down the leg. This study analyzes the laparoscopic surgical treatments of pelvic piriformis syndrome. Presentation: We report two cases of pelvic piriformis syndrome diagnosed in our hospital. The first case was a 40 years old woman with a 7-year history of intermittent low back and sciatalgia on her right side. The severity of the pain was 10/10 on the visual analog scale(VAS). Hyperesthesia and cutaneous allodynia were observed in the right sciatic nerve dermatome. The laparoscopic decompression surgery was performed to release the right sciatic nerve from the aberrant piriformis muscle. Postoperative 3 and 6 months follow-up, her VAS decreased to 0/10. The second case was a 30 years old woman with a 2-year history of sciatalgia on her left side. Her VAS was 9/10. The laparoscopic decompression surgery was performed to release the left sciatic nerve and left sacral nerve S2 dermatome from the aberrant piriformis muscle. Postoperative 3 and 6 months follow-up, her VAS decreased to 1/10. Conclusion: Due to the very few cases in the literature, pelvic piriformis syndrome is thought to be an exclusively clinical diagnosis. If the sciatica is refractory despite appropriate conservative treatments; laparoscopic exploration of the pelvic nerves and piriformis muscle and decompression surgery can be a good option. Keywords: Laparoscopy, pain, piriformis muscle syndrome, sacral nerve root, the sciatic nerve.

Introduction: Endometriosis is characterized by the presence of endometrial cells anywhere outside the uterine cavity. Endometriosis has been encountered on surgical scars especially resulting from a cesarean section recently. Our aim was to investigate the patients with abdominal wall endometriosis in our clinics where all the patients having this disease are managed via surgical resection. We also compared them with the patients presented in the literature. Methods: A study was conducted on the patients with histopathological diagnosis of abdominal wall endometriosis as a case series. All the subjects were analyzed through a comprehensive medical assessment including documentation of the detailed history and physical and gynecological examination based on the patients’ medical records. Results: A total of 53 patients diagnosed with abdominal wall endometriosis were included in this study. The mean age and the mean body mass index of the patients were 32.6 ± 6.5 years and 25.2 ± 3.5 kg/m2, respectively. A total of 49 patients had at least one operation history, mainly cesarean section. The most common sites for abdominal wall endometriosis were skin and the region containing the rectus abdominis muscle and rectus sheath, 56.6% and 18.9% respectively. The main symptom was the pain getting worse during menstruation and the presence of a mass in all patients. The main diagnostic tools in all patients were detailed history and physical examination, ultrasonography, and then histopathological confirmation after surgical excision. Conclusion: Abdominal wall endometriosis is a common diagnosis mainly due to increased cesarean section rate. Clinical suspicion has the most important place in correct diagnosis and management of abdominal wall endometriosis.

Aim The purpose of this study was to assess the feasibility and efficacy of transvaginal natural orifice transluminal endoscopic surgery (v-NOTES) staging surgery for extreme obese patients with early-stage type-1 endometrial cancer. Methods Study included cases of extreme obese patients with early-stage endometrial cancer who underwent v-NOTES between January 2019 and June 2019 at a tertiary referral medical center. The following parameters were noted: patient age, body mass index (BMI), operating time, conversion to conventional laparoscopy or laparotomy, any intraoperative or postoperative complications, estimated blood loss, pre- and postoperative hemoglobin levels, postoperative pain scores of the patients using visual analogue scale (VAS) at 6th, 12th and 24th h, length of hospital stay and final pathology report. Results Six cases of extreme obese patients with early-stage endometrial cancer underwent hysterectomy and bilateral salpingo-oophorectomy via the transvaginal NOTES. These six patients had a mean body mass index of 51.4 kg/m2 (SD = 6,13). No conversion to conventional laparoscopy or even laparotomy was needed in any of these patients. No adjuvant therapy was needed since all of the patients had early-stage endometrial carcinoma. Conclusion Given the increased risk of surgical morbidity and mortality associated with increasing BMI, it is paramount importance to establish safe surgical approaches to gynecological pathologies. We think that v-NOTES offers greater benefit to obese patients when performed by an experienced surgeon and v-NOTES is a safe, effective and feasible minimally invasive surgery in extreme obese patients with early endometrial cancer.

Objective To assess the reliability of YouTube® endometrioma cystectomy videos based on technical video analysis and considering the surgical steps. Material and method The present study yielded 756 videos after a search on YouTube® with the keywords “endometriosis cystectomy, endometrioma cystectomy, chocolate cyst cystectomy, and endometrioma surgery’’ during the period from January 7, 2007 to January 7, 2019. The viewer interest parameters such as total number of subscribers, views, likes, dislikes, comments, source of the videos, and the date of upload were assessed. Besides, the surgical steps were also evaluated considering committee suggestions. Results There were 140 (78.7 %) videos in Group 1 (not useful and slightly useful) and 38 (21.3 %) videos in Group 2 (useful and very useful). The mean numbers of subscribers, views, and likes were 5737.843 ± 15741.302, 10614.257 ± 32702.339, and 17.7 ± 43.57, respectively, in Group 1, and 851.052 ± 1613.599, 8192.55 ± 15989.955, and 11.92 ± 27.52, respectively, in Group 2. The type of surgery was significantly different between the study groups. The videos of cases with robotic surgeries presented more useful descriptive information (p = 0.003). There was a significant difference between the study groups regarding the type of hemostasis. The presence of didactic steps was higher in Group 2 (47.4 %) compared to Group 1 (28.6 %) (p = 0.02) Conclusions Overall, only around 21 % of YouTube videos presenting endometrioma surgery were defined as useful or very useful. The interest rates of the viewers may not compatible with the usefulness rate of the videos.

The nerves located in the deepest areas can be exposed and dissected via laparoscopic magnification. This technological innovation does not only help us to avoid surgery-related complications but also allows us to diagnose the vascular entrapment syndromes. The aim of this article is to demonstrate female neuroanatomy and autonomic plexus via enriched photos and videos to reveal the relationship of the pelvic nervous system with gynecological operations.

Background/Aims: The objective of this study was to compare the depth and width of thermal spread caused on rat uterine tissue after application of 3 different electrosurgical generators. Methods: Alsa Excell 350 MCDSe (Unit A), Meditom DT-400P (Unit M), and ERBE Erbotom VIO 300 D (Unit E) electrosurgical units (ESUs) were used. The number of Wistar Hannover rats required to obtain valid results was 10. The primary objective of the study was to compare the 3 ESUs using the same instrument and the same waveform. The secondary objective of the study was to compare the differences between monopolar and bipolar systems of each ESU separately using the same waveform. Results: The thermal spread caused by each ESU using monopolar instruments with continuous and interrupted waveforms was significantly different. Among the 3 devices, Unit A caused the largest thermal uterine tissue spread. On the other hand, Unit E caused the most superficial thermal tissue spread, and the smallest thermal spread among all ESUs. Conclusions: Surgeons should note that different ESUs used with the same power output might create different thermal effects especially in the monopolar configuration within the same waveform, for the same duration, and with the same instrument.

Objective: Most surgeons prefer to perform anterior abdominal wall lifting during abdominal entry to avoid damage to intestines or main vessels. Anterior abdominal wall lifting is assumed to prevent vital organ injuries by creating an adequate distance prior to entry into the peritoneal cavity. In this study, we compared the distance created for trocar entry into the peritoneal cavity with towel clamp lifting and towel clamp plus manual elevation of the anterior abdominal wall. Material and Methods: Forty patients who underwent various laparoscopic procedures were enrolled. The study was performed in two steps: first the anterior abdominal wall was lifted using towel clamps (TC group), next the anterior abdominal wall was lifted via maximal manual elevation from the lower abdomen in addition to towel clamps (TCM group). The insertion distance of a plastic ruler into the abdomen was measured from the parietal peritoneum to the intra-abdominal structure in both groups. Results: There was a statistically significant difference between the two groups (TC group 3.9±1.5 cm vs. TCM group 4.5±1.5 cm, p

Study Objective To demonstrate the robot-assisted laparoscopic decompression approach to treat aberrant vessels entrapping the sacral nerves causing motor deficit. Design Video presentation of two cases. Setting Tertiary unit specializing in advanced gynecologic surgery and neuropelveology. Patients or Participants Case 1: A 23-year-old virgin female patient presented with right lower extremity weakness, which had progressed into a limp over the past year and dysmenorrhea with a VAS (visual analog scale) score of 10. Gynecological examination revealed a 2 cm endometrioma on the right ovary. Under neurological examination hypoesthesia on right peroneal and right tibial nerve-dermatomes and chronic denervation of the muscles innervated by L5-S1 were observed. Case 2: A 46-year-old gravidity 3 parity 3 female patient presented with non-menstrual left sciatic pain, which caused difficulties while wearing socks and high heels and climbing up stairs. Magnetic resonance imaging (MRI) revealed dilated vessels on the left sacral nerve roots. Interventions Robot-assisted laparoscopic sacral nerve decompression Measurements and Main Results Patients were evaluated at 3rd and 6th month postoperatively. First patient's electromyography (EMG) result was normal at the 3rd month control. Motor deficit of both patients were eliminated and they both recovered fully. Conclusion Motor deficit or pain radiating (i.e. sciatica) to lower extremities are usually caused by spinal cord problems. However, these symptoms could arise by anatomic structures obstructing the nerves travelling to target organs or by nerve injuries. Since lumbosacral plexus is located over the sacral bone, it can be compressed easily by abnormal vessels crossing over the plexus. Accessing to the sacral plexus between lateral iliac vessels and iliopsoas muscle is crucial and stable instruments are crucial during surgery. Robotic-assisted laparoscopy allows this stability and decrease the possibility of complications. The robotic technique offers, three-dimensional vision, improved maneuverability and enhanced ergonomics in the deepest parts of the pelvis.

Endometriosis is a benign gynecologic disorder. It is particularly common among young women and may make pregnancy difficult. In this study molecular level characterization of endometriosis tissues were performed using Raman spectroscopy in combination with multivariate statistical analysis. Three hundred sixty six Raman spectra recorded from different points of seventy two tissue samples, taken from the cyst walls of twelve patients were examined. Principle component analysis (PCA) followed by linear discriminant analysis (LDA) were performed on the Raman data, and the samples were then classified into three groups: severe, moderate, and weak endometriosis. In the severe endometriosis group, the relative band intensities of DNA were increased. Moreover, increase in pyrrole moieties and kynurenine were seen. The results show that endometriosis severity correlates to increase in DNA concentration, and degradation of tryptophan due to increased indoleamine-pyrrole 2,3-dioxygenase (IDO) activity, and an increase in kynurenine concentration and pyrrole intermediate. It is concluded that Raman spectroscopy is capable of providing a quick diagnosis, ahead of the pathology result being reported. Istanbul University

Introduction:The aim of this case to present a woman with neurovascular entrapment causing persistent sciatica. We presented the surgical management and the feasibility, safety, and early postoperative outcomes, as well as step-by-step explanation of the surgical technique that it was enriched via original video footage.Case description:A 29-year-old woman has been suffering from chronic pelvic pain and sciatica for 1 year. She had received medical physical treatment for 6 months and did not have any response to pain. Her visual analog scale score was 8/10 points. Neurovascular entrapment was considered as a preliminary diagnosis. The laparoscopic approach showed that an aberrant hypogastric vein branch compressing the sciatic nerve and sacral 2 nerve root. The decompression of these nerves was performed successfully. The total operation time was 50 min. There was no intraoperative and postoperative complication. The visual analog scale score on the postoperative 24th-h was 1/10 point (on 11-point numeric scale). The patient was discharged on the second day postoperatively. In the first-month follow-up, patient’s visual analog scale score was 7/10 point (on 11-point numeric scale). In the 12th-month follow-up, patient’s pelvic pain has decreased dramatically (visual analog scale score rate was 0/10 point) and also had no dyspareunia.Conclusion:A gynecologist should be aware of diagnosis of vascular entrapment in the chronic pelvic pain. Moreover, knowledge of pelvic neuroanatomy and clinical neurology is mandatory for surgeons. The surgical management of neurovascular entrapment is a safe, feasible, and curative option when performed by experienced surgeons.

Endometriosis is an estrogen-dependent disease that affects 5 to 15% of women of reproductive age. Data from large-cohort and case-control studies indicate an increased risk for ovarian cancers in women with endometrioma. Recently, as an ovarian cancer biomarker, human epididymal secretory protein E4 (HE4) has been increasingly investigated in the differentiating of endometrioma from ovary malignancy and in confirming the benign structure of the endometrioma. This case series study describes women who underwent surgery due to increased serum HE4 levels and higher Risk of Ovarian Malignancy Algorithm (ROMA) index, in whom the final pathology was reported as benign, although, ultrasonography and magnetic resonance imaging (MRI) findings showed features of "typical" endometrioma.

The aim of this video is to demonstrate the alternative technique of robot-assisted laparoscopic pectouteropexy for uterus preservation in obese patients with pelvic organ prolapse. We present the case report of a 44-year-old patient with apical pelvic organ prolapse. A pelvic examination was performed during a Valsalva maneuver in the dorsal lithotomy position and in the standing position, and the patient was diagnosed with stage III apical prolapse in accordance with the Pelvic Organ Prolapse Quantification system of the International Continence Society (POP-Q: Аа -1, Ва 0, Вр 0, С +2). We performed the procedure, which was developed as an alternative to sacrocolpopexy or sacrouteropexy, as described by Banerjee and Noé (Arch Gynecol Obstet 284:24-28, 2011). Pectouteropexy is a new method for prolapse surgery that uses the lateral parts of the iliopectineal ligament for bilateral mesh fixation of the descended structures and provides strong apical support. We believe that robot-assisted laparoscopic pectouteropexy is a valuable alternative approach for uterus-preserving pelvic organ prolapse surgery owing to its better robot maneuverability, reduced operating time, and better visualization in obese patients.

Study Objective To report outcomes of the vascular entrapment of the sacral plexus treated by minimally invasive surgery. Design Retrospective cohort study. Setting Tertiary unit specializing in advanced gynecologic surgery and neuropelveology. Patients or Participants A total of 23 patients suffering from chronic pelvic pain with the involvement of the lumbosacral plexus were included in this study. 9 out of 23 patients underwent robot-assisted laparoscopic surgery and conventional laparoscopic surgery with 3D technology were performed in 14 patients for treatment of the vascular entrapment of the lumbosacral plexus. Interventions Laparoscopic or robot-assisted laparoscopic excision of the abnormal vessels located on the lumbosacral plexus and decompression of the nerve roots. Measurements and Main Results The mean age of the patients was 35.13. All patients were suffering from chronic pelvic pain and the most common coexisting symptoms were dysmenorrhea, sciatica, vulvodynia and pudendal neuralgia. Motor deficit was seen only in two patients. Vascular entrapment was visualized on the left side in 16 patients and on the right side in 7 patients. Vascular entrapment of the lumbosacral plexus in different locations were first dissected then clipped (in 12 patients), coagulated and cut in all patients. Thrombosis of the external iliac artery occurred in one patient, postoperatively. In two patients pain persisted following operation and recurrence was observed in one patient. Conclusion Since lumbosacral plexus is located over the sacral bone, it can be entrapped easily by abnormal vessels crossing over the plexus. Radiating pain to lower limbs or genital area and also motor deficit of the lower limbs in patients with chronic pelvic pain were investigated in detail for the presence of vascular entrapment of the lumbosacral plexus. The minimally invasive surgery with three-dimensional vision provides improvement of the sensation of depth in the deepest parts of the pelvis and minimizes complications.

Study Objective To demonstrate decompression of sacral nerves from aberrant vessels and fibrous tissue located on the plexus. Design Video presentation of two cases. Setting Tertiary center specializing in advanced gynecologic surgery and neuropelveology. Patients or Participants Case 1: A 43-year-old gravidity 1 parity 1 female patient presented with dysmenorrhea, dyspareunia and pudendal pain with dysuria. Gynecological examination revealed deep infiltrative endometriosis with rectovaginal nodule and partial obliteration of pouch of Douglas. She had a history of laparoscopic endometriosis surgery with left oophorectomy and was treated with intravascular coil embolization for pelvic congestion syndrome. Case 2: A 41-year-old gravidity 1 parity 1 female patient presented with chronic pelvic pain and left sided sciatic pain with chronic dysesthesia in the dermatome of sciatic nerve without any motor deficit of lower extremity. Gynecological examination revealed deep infiltrative endometriosis and full obliteration of pouch of Douglas. She had a history of multiple laparoscopic and laparotomic operations for endometriosis. Interventions Robot-assisted laparoscopic sacral nerve decompression and dissection of cul-de-sac with rectal nodule shaving (case1) and laparoscopic sacral nerve decompression and dissection of cul-de-sac (case 2). Measurements and Main Results Patients were evaluated at 3rd and 6th month postoperatively. Both patients report significant pain reduction with visual analog scale score. Conclusion Since lumbosacral plexus is located over the sacral bone, it can be compressed easily by an abnormal structure (abnormal vessels, fibrous tissue, tumor, etc.) located on the plexus. Deep infiltrative endometriosis may affect retroperitoneal tissue by causing fibrosis. An abnormal vessel, which is located on the sacral plexus may entrap the roots much easier with coexisting fibrosis. On six moths follow up the visual analog scale score of case 1 and 2 decreased from 10 to 4 and 10 to 3, respectively. Patients are still under surveillance.

Background. The obstetrics and gynecology literature has expanded in recent years to include clinical trials assessing the use of barbed sutures. The difficulty of intracorporeal suturing continues to be a barrier to a wider use of laparoscopy. Although the use of barbed sutures has been shown to ease the process of laparoscopic suturing considerably, concerns have been raised regarding a potentially increased risk of adhesions or inflammation as a result of their use. Objectives. The aim of this study was to determine whether differences in surface textures, resulting from the variations in the geometric configurations of barbs, lead to differences in intra-abdominal adhesion formation. Material and methods. A total of 27 non-pregnant female Wistar Hannover rats, weighing 200-250 g, with intact uteri were used as an adhesion formation model. The rats were randomly assigned to 3 groups: barbed suture group 1, barbed suture group 2 and control group ( no intracorporeal suture). A 2-centimeter vertical incision was performed on the anti-mesosalpingeal side of one of the uterine horns. The incision on the uterine horn was reapproximated with a running suture, entailing 3 needle punctures and left untied at one end. Six weeks after the operation, intra-abdominal adhesion formations were investigated both clinically and histopathologically. Results. Clinical adhesion scores and histopathological parameters in both the barbed suture groups were statistically significantly higher than in the control group (p < 0.05). There was no significant difference between the barbed suture groups regarding the adhesion scores. Conclusions. The 2 types of barbed sutures with different surface textures, used for myometrial closure, form a similar profile with respect to postoperative adhesion formation.

Purpose: Pudendal neuralgia (PN) is a painful and disabling condition, which reduces the quality of life as well. Pudendal nerve infiltrations are essential for the diagnosis and the management of PN. The purpose of this study was to compare the effectiveness of finger-guided transvaginal pudendal nerve infiltration (TV-PNI) technique and the ultrasound-guided transgluteal pudendal nerve infiltration (TG-PNI) technique. Methods: Forty patients who underwent PNI for the diagnosis of PN were evaluated. Thirty-five of these 40 patients, who were diagnosed as PN, underwent a total of 70 further unilateral PNI. All the patients underwent PNI for twice after the first diagnostic PNI, 1 week apart. Results: In the ultrasound (US)-guided TG-PNI group, the success rate was 68.8\% (11 of 16) in both ``pain in the sitting position{''} and ``pain in the region from the anus to the clitoris:{''} The success rate of blocks in the US-guided TG-PNI group was 75\% (12 of 16) in terms of pain during/after intercourse. In the finger-guided TV-PNI group, the success rate was 84.2\% in both ``pain in the sitting position{''} and ``pain in the region from the anus to the clitoris:{''} The success rate of blocks in the finger-guided TV-PNI group was 89.5\% (17 of 19) in terms of pain during/after intercourse. There was no statistically significant difference in the success rate of the 3 assessed conditions between the 2 groups (P> 0.05). Conclusions: The TV-PNI may be an alternative to US-guidance technique as a safe, simple, effective approach in pudendal nerve blocks.

The present study was conducted to identify endometrial and myometrial lesions coexisting with adenomyosis, and to evaluate the clinicopathological characteristics of endometrial adenocarcinomas associated with adenomyosis. A retrospective analysis of the resected uterine specimens of 319 patients with adenomyosis admitted between January 1, 2014 and August 1, 2017 was performed. The endometrial and myometrial lesions coexisting with adenomyosis were evaluated. The clinicopathological prognostic factors, including tumor grade, myometrial invasion, lymphovascular space involvement, lymph node invasion, pathological stage and recurrence, were analysed. For data analysis, the Chi-squared test was used and a P-value of

PURPOSE OF REVIEW This article reviews the potential benefits and disadvantages of new three-dimensional (3D) high-definition laparoscopic surgery for gynaecology. RECENT FINDINGS With the new-generation 3D high-definition laparoscopic vision systems (LVSs), operation time and learning period are reduced and procedural error margin is decreased. New-generation 3D high-definition LVSs enable to reduce operation time both for novice and experienced surgeons. Headache, eye fatigue or nausea reported with first-generation systems are not different than two-dimensional (2D) LVSs. The system's being more expensive, having the obligation to wear glasses, big and heavy camera probe in some of the devices are accounted for negative aspects of the system that need to be improved. SUMMARY Depth loss in tissues in 2D LVSs and associated adverse events can be eliminated with 3D high-definition LVSs. By virtue of faster learning curve, shorter operation time, reduced error margin and lack of side-effects reported by surgeons with first-generation systems, 3D LVSs seem to be a strong competition to classical laparoscopic imaging systems. Thanks to technological advancements, using lighter and smaller cameras and monitors without glasses is in the near future.

The aim of the study was to compare postoperative vaginal cuff complications due to the use of barbed sutures (V-Loc™ 180 unidirectional suture; Covidien, Mansfield, MA) and standard braided sutures (Vicryl®; Ethicon Inc., Somerville, MA) during vaginal cuff closure of patients undergoing a total laparoscopic hysterectomy (TLH) due to benign diseases. Eighty-nine patients were in the standard suture group and 208 patients were included in the barbed suture group. Vaginal cuff dehiscence was identified in only three (3.3%) patients within the standard suture group and none in the barbed suture group. Five (5.6%) patients in the standard suture group and two (0.9%) patients in the barbed suture group developed postoperative cuff infection/cellulitis. Duration of the surgery was significantly shorter in the barbed suture group than in the standard suture group (p

Objective: To share our first experience with laparoscopic pectopexy, a new technique for apical prolapse surgery, and to evaluate the feasibility of this technique. Materials and Methods: Seven patients with apical prolapse underwent surgery with laparoscopic pectopexy. The lateral parts of the iliopectineal ligament were used for a bilateral mesh fixation of the descended structures. The medical records of the patients were reviewed, and the short-term clinical outcomes were analyzed. Results: The laparoscopic pectopexy procedures were successfully performed, without intraoperative and postoperative complications. De novo apical prolapse, de novo urgency, de novo constipation, stress urinary incontinence, anterior and lateral defect cystoceles, and rectoceles did not occur in any of the patients during a 6-month follow-up period. Conclusion: Although laparoscopic sacrocolpopexy has shown excellent anatomical and functional long-term results, laparoscopic pectopexy offers a feasible, safe, and comfortable alternative for apical prolapse surgery. Pectopexy may increase a surgeon's technical perspective for apical prolapse surgery.

Study Objective To demonstrate the laparoscopic approach to malformed branches of the vessels entrapping the nerves of the sacral plexus. Design A step-by-step explanation of the surgery using video (educative video) (Canadian Task force classification II). The university's Ethics Committee ruled that approval was not required for this video. Setting Kocaeli Derince Education and Research Hospital, Kocaeli, Turkey. Patient A 26-year-old patient who had failed medical therapy and presented with complaints of numbness and burning pain on the right side of her vagina and pain radiating to her lower limbs for a period of approximately 36 months. Intervention The peritoneum was incised along the external iliac vessels, and these vessels were separated from the iliopsoas muscle on the right side of the pelvis. The laparoscopic decompression of intrapelvic vascular entrapment was performed at 3 sites: the lumbosacral trunk, sciatic nerve, and pudendal nerve. The aberrant dilated veins were gently dissected from nerves, and then coagulated and cut with the LigaSure sealing device (Medtronic, Minneapolis, Minn). Measurements and Main Results The operation was completed successfully with no complications, and the patient was discharged from the hospital 24 hours after the operation. At a 6-month follow-up, she reported complete resolution of dyspareunia and sciatica (visual analog scale score 1 of 10). Conclusion A less well-known cause of chronic pelvic pain is compression of the sacral plexus by dilated or malformed branches of the internal iliac vessels. Laparoscopic management of vascular entrapment of the sacral plexus has been described by Possover et al 1 , 2 and Lemos et al [3] . This procedure appears to be feasible and effective, but requires significant experience and familiarity with laparoscopy techniques and pelvic nerve anatomy.

Endometriosis is a benign gynecologic disorder. It is particularly common among young women and may make pregnancy difficult. In this study molecular level characterization of endometriosis tissues were performed using Raman spectroscopy in combination with multivariate statistical analysis. Three hundred sixty-six Raman spectra recorded from different points of seventy two tissue samples, taken from the cyst walls of twelve patients were examined. Principle Component Analysis (PCA) followed by Linear Discriminant Analysis (LDA) were performed on the Raman data, and the samples were then classified into three groups; severe, moderate, and weak endometriosis. In the severe endometriosis group, the relative band intensities of DNA were increased. Moreover, increase in pyrrole moieties and kynurenine were seen. The results show that endometriosis severity correlates to increase in DNA concentration, and degradation of tryptophan due to increased indoleamine-pyrrole 2, 3-dioxygenase (IDO) activity, and an increase in kynurenine concentration and pyrrole intermediate. It is concluded that Raman spectroscopy is capable of providing a quick diagnosis, ahead of the pathology result being reported. Keywords: Endometriosis; Raman spectra, PCA-LDA analysis.

Background: The aims of this retrospective study were to evaluate the maternal and prenatal outcomes between 35 years and older pregnancies and younger pregnancies, and the effects of the age of pregnancy, mother and newborn. Methods: Pregnant women who gave birth in Vakif Gureba Training and Research Hospital, Clinic of Obstetrics and Gynecology in 2006 were retrospectively screened. Pregnant women aged 35 years and over were included in this study and the pregnant women between age range of 30 - 34 years were included in the control group. Results: Pregnancy rate was found as 7.1% in 35 years and older women in all the deliveries, cesarean delivery rate was found as 46.1% in this group at 1 year period. However, cesarean delivery rate was 40.9% in the control group. Cesarean delivery rate was found as 31.6% in all the deliveries. The most common cause of cesarean section indication was fetal distress in advanced maternal age (AMA) (11.7%), whereas previous cesarean section was found as the most common cause in the control group (15.1%). Conclusion: No significant difference was found between AMA group and normal pregnancies in terms of preterm labor, caesarian section, morbidity, mortality and chronic diseases such as hypertension and diabetes mellitus. J Clin Med Res. 2015;7(2):97-102 doi: http://dx.doi.org/10.14740/jocmr1904w

Objective We assess follicular reserve changes by follicle count in torsion–detorsion rat model. Study design 30 albino rats were randomly divided into 3 groups: sham group (SG), detorsion after 24-hour torsion group (24hTG) and detorsion after 72-hour torsion group (72hTG). Ovaries were torsioned and fixed. They were untwisted 24 and 72 h later. Oophorectomies were performed at 14th day after detorsion. Tissue damage scoring and follicle counts were evaluated microscopically. Results Tissue damage scores (TDSs) were higher in 72hTG and 24hTG compared to SG. In addition, as we increase torsion duration, TDSs also increased. There was no statistically significant difference in follicle numbers (primordial, primary, secondary and tertiary). Conclusion Duration of torsion and intensity of ovarian damage do not affect follicular reserve in a rat model. Regardless of their macroscopic appearance, ovaries maintain their follicle reserves after torsion. Thus, surgeons should be reassured and encouraged to untwist torsioned ovaries rather than removing them.

Aim The aim of our study was to evaluate the level of knowledge of the adolescent girls who presented to our clinic about human papilloma virus (HPV) infection and HPV vaccine. Material and methods Five hundred and one adolescent girls aged between 13 and 18 years who presented to the gynecology outpatient clinic between March 2012 and March 2013 were asked to answer the questions of the questionnaire about HPV and HPV vaccine. The "Participant Information Form" and "HPV Information Assessment Form" were used by examination of the related literature by the investigators. The data obtained were entered into the computer using the SPSS 16.5 program and evaluated. Descriptive statistics were shown with mean, standard deviation, number and percentage values. Results The mean age of 501 subjects who were included into the study was 15.92 years. 390 subjects (77.8%) who were included in the study had no information about HPV. 111 subjects (22.2%) stated that they heard of HPV before or had information about HPV. The mean age of the subjects who had information about human papilloma virus was found to be 16.52 years. The mean age of 390 subjects (77.8%) who had no information about human papilloma virus was 15.75 years. It was found that only one of the subjects (0.9%) was vaccinated with HPV vaccine. When the subjects who did not wish to be vaccinated were asked for the reason, 40.9% stated that the reason was inadequate information, 26.4% stated that the reason was high cost, 16.4% stated that the reason was the fact that they did not consider themselves at risk and 16.4% stated that the reason was the fact that they were afraid of side effects. Conclusions In our study, it was found that the adolescent girls who constituted our study group had insufficient information about HPV and HPV vaccine. Verbal, written and visual communication tools and internet should be used intensively and efficiently for the objective of introducing HPV vaccine and teaching the precautions related with prevention of cervix cancer in terms of public health. Primarily pediatrician and gynecologists and family physicians who give service for the adolescence age group should be supported to develop appropriate attitudes and behaviors related with HPV vaccine and infection.

Aim The objective of this study was to compare classical blind endometrial tissue sampling with hysteroscopic biopsy sampling following methylene blue dyeing in premenopausal and postmenopausal patients with abnormal uterine bleeding. Material and Methods A prospective case–control study was carried out in the Office Hysteroscopy Unit. Fifty-four patients with complaints of abnormal uterine bleeding were evaluated. Data of 38 patients were included in the statistical analysis. Three groups were compared by examining samples obtained through hysteroscopic biopsy before and after methylene blue dyeing, and classical blind endometrial tissue sampling. First, uterine cavity was evaluated with office hysteroscopy. Methylene blue dye was administered through the hysteroscopic inlet. Tissue samples were obtained from stained and non-stained areas. Blind endometrial sampling was performed in the same patients immediately after the hysteroscopy procedure. The results of hysteroscopic biopsy from methylene blue stained and non-stained areas and blind biopsy were compared. Results No statistically significant differences were determined in the comparison of biopsy samples obtained from methylene-blue stained, non-stained areas and blind biopsy (P > 0.05). Conclusions We suggest that chromohysteroscopy is not superior to endometrial sampling in cases of abnormal uterine bleeding. Further studies with greater sample sizes should be performed to assess the validity of routine use of endometrial dyeing.