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    Comparison of Gyrus PKS™ PlasmaSpatula Versus Vectec™ Monopolar L-Hook During Colpotomy Step in Total Laparoscopic Hysterectomy in Terms of Vaginal Cuff Thermal Damage
    (2022) Çimşir, Meral Tuğba; Yıldız, Muhammet Serhat; Günizi, Ceren
    Objective: Thermal injury is a complication that can develop during laparoscopic hysterectomy. The ureter, which is located close to the surgical margin, may be damaged, especially due to the thermal effect created by the electrosurgical devices used in the colpotomy step. The aim of this study is to compare the vaginal cuff thermal injury caused by 2 different energy-based surgical devices used in the colpotomy step in total laparoscopic hysterectomy. Methods: The study included 55 patients who underwent laparoscopic hysterectomy. Patients were randomly assigned to the Bipolar Gyrus® PKS PlasmaSpatula (Gyrus-ACMI, Maple Grove, MA) cutting device group (n = 27) or the Monopolar L-Hook (VECTEC, Bioparc, Hauterive, France) cutting device group (n = 28), and colpotomy was performed using the assigned energy-based surgical device for each group. The removed uterus was examined by the same pathologist in the pathology department. During the colpotomy stage, the thermally damaged area was measured and photographed in millimeters from the application point of the electrosurgical device at the cervix–vaginal border. The extent of lateral thermal damage was measured in width using a light microscope from the point of instrument application to the margin of unchanged nearby tissue. Results: Thermal damage was significantly greater in the Monopolar L-Hook group than in the Bipolar Gyrus ® PKS PlasmaSpatula cutting device group (8.1 mm [range 6.6-9.1 mm] vs. 4.7 mm [range 4.1-5.6 mm], P = .000). However, Bipolar Gyrus ® PKS PlasmaSpatula provided a better surgical field as it did not produce excessive smoke and caused less thermal damage. The colpotomy time, cuff closure time, total operative time, blood loss, and cuff cellulite were similar between the 2 groups. Conclusion: Bipolar Gyrus ® PKS PlasmaSpatula caused less lateral thermal damage and provided a better non-smoked surgical view compared to the Monopolar L-Hook cutting device
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    Comparison of obstetric and neonatal outcomes between Syrian adolescent refugees and local Turkish adolescent citizens
    (2022) Yıldız, Muhammet Serhat; Çimşir, Meral Tuğba
    The provision of antenatal care in adolescents in refugee populations presents particular difficulties because of conflict, nutritional deficiencies, language barriers and lack of access to health care facilities. Due to the absence of prenatal care, associated medical complications can occur. A total of 525 adolescent women who gave birth to singletons agreed to participate in this study. Data about maternal demographic and obstetric characteristics, as well as neonatal outcomes were analysed. In conclusion, adolescent pregnancy continues to be an important social problem due to health support needs. However, the results of our present study are important in terms of showing that perinatal care is quietly improving in Turkey. • What is already known on this subject? Adolescent pregnancies are at much higher risk than adult pregnancies in terms of complications. These complications include preterm delivery, intrauterine growth retardation, maternal morbidity and mortality, neonatal morbidity and mortality. According to various beliefs and traditions, marriages in early ages are observed in some societies and as a result, adolescents become pregnant. Additionally, the present study includes early adolescent aged pregnancies as 14,15 and 16. As far as we search in the literature, there is no reported about early adolescent pregnancies. • What do the results of this study add? Often, such pregnancies occur more frequently in societies with low socioeconomic levels. For this reason routine pregnancy screening, support during pregnancy, prenatal care is not adequately provided. Some of the complications develop on them. Primarily, the adolescent pregnancies should be gotten under control, if not, some complications can be prevented by routine pregnancy follow-up and adequate provision of prenatal care and support. • What are the implications of these findings for clinical practice and/or further research? As a guide on clinical practices and further studies; an effective method of contraception should be applied to sexually active women at early maternal age. If not, pregnancies should be kept under close follow-up and with adequate support to avoid complications.
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    Could fibrinogen to albumin ratio be a predictive marker for recurrent pregnancy loss
    (2021) Çimşir, Meral Tuğba; Yıldız, Muhammet Serhat
    Aims Recurrent pregnancy loss (RPL) is usually defined by two or more consecutive clinical miscarriages, which causes psychological trauma for couples. In this study, we aimed to investigate the predictive role of fibrinogen to albumin ratio (FAR) in patients with RPL. Methods Pregnant women in their first trimester of pregnancy were included in the study and divided into two groups as RPL patients (n: 44) and patients with no previous recurrent miscarriage (n: 60) as control group. Demographical parameters and routine blood parameters (fibrinogen, D-dimer, FAR, neutrophil to lymphocyte ratio [NLR], platelet count, main platelet volume [MPV], and red cell distribution width [RDW] values) were compared between the RPL group and the control group. Results The groups were determined to be statistically different in regard to gravidity and parity (P < .001). The difference between the groups was statistically different in regard to fibrinogen (mg/dL), albumin (g/dL), FAR (%), NLR (%), RDW-coefficient of variation (%), RDW-standard deviation (fl), and platelet counts (10(-3)/mu L). However, MPV (fl) and D-dimer (mu g/L) levels were similar in both groups. The receiver operating characteristic curve analysis revealed that the NLR levels were 84.1% sensitive and 75% specific with a cut-off value of 4.27 and the FAR levels were 79.5% sensitive and 88.3% specific with a cut-off value of 105.69 for predicting RPL. Conclusion Our results indicate that the FAR and NLR levels seem to be effective parameters for predicting RPL with high sensitivity and specificity.
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    Laparoscopic lateral suspension to treat neovaginal prolapse in a patient with Mayer–Rokitansky–Kuster–Hauser syndrome: A rare case report
    (Blackwell Publishing, 2021) Mülayim, Barış; Çimşir, Meral Tuğba
    Various methods have been described to treat neovaginal prolapse in patients with Mayer–Rokitansky–Küster–Hauser (MRKH) syndrome. In this case report, we describe neovaginal prolapse of a 21-year-old patient with MRKH syndrome which had been created by sexual intercourse dilation. Herein, the laparoscopic lateral suspension was performed for the surgical correction of neovaginal prolapse which is not available in the literature as far as we search. Prolapse was successfully corrected and vaginal length was provided at a sufficient length of 7 cm. Since after 1-year of operation, she has remained satisfied with her surgical outcome anatomically, sexually and psychologically. Laparoscopic lateral suspension is a safe and effective treatment in a patient who has neovaginal prolapse with MRKH syndrome and also can be used as a potentially alternative management in the treatment of neovaginal prolapse in patients with MRKH syndrome. © 2020 Japan Society of Obstetrics and Gynecology