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Öğe ÇOCUKLAR İÇİN ÖZEL GEREKSİNİM RAPORU (ÇÖZGER)’NA BAŞVURAN OLGULARIN PSİKİYATRİK TANI VE ÖZEL GEREKSİNİM DÜZEYLERİNİN ÖNCEKİ YÖNETMELİKTEKİ TANI VE ÖZÜR ORANLARI İLE KARŞILAŞTIRILMASI: RETROSPEKTİF ÇALIŞMA(2022) Akar, Bertan; Doğan, Ozan; Köle, Emre; Caliskan, ErayAmaç: Tekrarlayan implantasyon başarısızlığı (RIF) zorlu bir gerçek olduğundan, bu sorunun üstesinden gelmek için farklı terapötik immünomodülatör ajanların etkileri araştırılmaktadır. Bu çalışma, intralipidin RIF'li IVF hastalarının gebelik sonuçları üzerindeki etkisini değerlendirmeyi amaçlamıştır. Yöntem: Katılımcıların 116'sı sadece kısa antagonist protokolünü alan kontrol grubuna, 106'sı ise intravenöz lipid (SMOFlipid®) verilerek intralipid grubunda yer aldı. İntralipid, embriyo transferinin olduğu gün, pozitif gebelik testinin olduğu gün verildi ve gebeliğin onuncu haftasına kadar haftalık olarak devam edildi. İmplantasyon oranı, biyokimyasal gebelik oranı, klinik gebelik oranı ve canlı doğum oranı değerlendirildi. Bulgular: Pozitif gebelik testi, klinik gebelik oranı ve canlı doğum oranı İntralipid grubunda istatistiksel olarak anlamlıydı (p<0,001) (sırasıyla %50,9'a karşı %22,4, %41.5'e karşı %19,8, %29,2'ye karşı %10,3) ). İmplantasyon, spontan abortus, çoğul gebelik ve kimyasal gebelik oranları açısından gruplar arasında anlamlı fark yoktu (p>0.05). Sonuç: Bu çalışma, intralipid tedavisinin, sadece standart IVF protokolü uygulanan hastalara kıyasla RIF'li hastalarda daha iyi gebelik sonuçlarına sahip olduğunu ortaya koymuştur. RIF'li hastalarda intralipidin rutin kullanımını önermek için daha ileri prospektif çalışmalara ihtiyaç vardır.Öğe Do the Levels of cffDNA Fraction Change in Pregnancies with Placental Problems?(2022) Akar, Bertan; Köle, Emre; Özcan, Canan; Çakır Köle, MerveObjective: To investigate the value of the cell free fetal DNA (cffDNA) for determining the important obstetric complications such as preeclampsia, intrauterine growth retardation (IUGR) and, preterm labor other than prenatal screening of fetal aneuploidies. Methods: Our single center- retrospective study included 131 pregnant women in their 10-24th weeks of gestation, between the dates September 2019 and March 2020 who applied for cffDNA analysis (HarmonyTM Prenatal Test; Ariosa Diagnostics Inc., San Jose, Calif., USA) with indications including advanced maternal age (?40) and high risk for trisomy 13.18 and 21 according to the results of the first trimester prenatal screening or solely on their own desire. Results: Oligohydraamnios was observed in 10 (8.1%) patients, gestational diabetes in 10 patients (8.1%), preeclampsia in 7 (8.6%) patients and ablatio plasenta in 2 (1.2%) patients in this study. Increasing levels of the extracellular fetal DNA fractions in 10-24th gestational weeks showed statistically significant correlation for predicting the risk for IUGR (p<0.01). There was not a statistically significant difference between the level of extracellular fetal DNA fractions and the other obstetric complications (preeclampsia, preterm labor, GDM, oligohydraamnios). Conclusion: Although cff-DNA has many valuable implications as a novel biomarker for prenatal screening for special fetal aneuploidies, the association between the levels of cff-DNA and the risk of obstetric complications in clinical practice has not been clarified yet . Further studies should aim to investigate the cff-DNA levels in patients with pathological obstetric conditions in order to detect its potential predictive value and diagnostic implementation.Öğe Donmuş embriyo transferi yapılan hastalarda D Vitamini düzeylerinin gebelik sonuçlarına etkisi(Kocaeli University, 2023) Köle, Merve Çakır; Köle, Emre; Görgülü, Gökşen; Candan, Barış; Güllüoğlu, Ahmet; Doğer, Emek; Aksoy, LaleAmaç: Donmuş embriyo transferi yapılan infertil hastalarda 25-OH vitamin D’nin gebelik sonuçlarına etkisini değerlendirmek. Yöntem: Kocaeli Üniversitesi Tıp Fakültesi Hastanesi, Üremeye Yardımcı Teknikler Merkezinde prospektif -tek kör olarak yürütülen bu çalışmada donmuş embriyo transferi (DET) yapılması planlanan 276 infertil olgunun serum 25-OH vitamin D düzeyleri tedavi başlangıcında elde edildi. 25-OH-D vitamini seviyelerinin yetmezlik seviyesinde düşük olduğu olgular (Öğe Evaluation of iliococcygeal fixation procedure for pelvic organ prolapse: preoperative properties and short term postoperative outcomes(2024) Köle, Emre; Hasanova, Ilaha; Şahin, Ramazan Oğuz; Ayanoglu, Esra; Aksoy, Lale; Deniz, Alparslan; Aslan, ErdoğanAim: The aim of this study was to evaluate the short-term outcomes of patients who underwent iliococcygeal fixation (ICF) for the surgical treatment of pelvic organ prolapse (POP) and to assess the safety and feasibility of the ICF procedure. Patients and Methods: Our study is retrospectively done with the data of 50 POP patients who underwent ICF in our clinic within the dates 01.04.2022 and 31.03.2024. A total of 44 women were found to be eligible for follow-up. Demographic data and pre- and post-operative clinical data at 3 months were assessed. Results: According to the findings of our study, the difference between the median duration of surgery in NSD and CS patients is statistically significant, and the duration of surgery is longer in NSD patients (80 minutes (70-85) vs 60 minutes (50 -67,5), (p<0,05)). Only one recurrence, one hematoma and infection, and one bladder injury had occurred. Conclusion: According to our study, ICF is a safe, durable and surgically feasible procedure that can be done concomitantly with other procedures. Thus, we strongly advocate this procedure until the ideal mesh is found since it avoids many serious complications of SSLF.Öğe Examination of pelvic structures of women with polycystic ovary syndrome using magnetic resonance imaging pelvimetry(2024) Köle, Emre; Özen, Selda; Deniz, Merve Erol; Kole, Merve Cakir; Deniz, Alparslan; Aksoy, Lale; Aslan, ErdoğanObjective: Our study aimed to evaluate patients with Polycystic Ovary Syndrome (PCOS) using Magnetic Resonance (MR) pelvimetry to determine if there is a specific pelvic type associated with hyperandrogenemia. Method: This study retrospectively analyzed data collected from pelvic MR imaging performed on 36 patients diagnosed with PCOS who attended the outpatient clinic of Alanya Education and Research Hospital between 2021 and 2022. All cases were of reproductive age, between 18 and 49 years, and were initially diagnosed with PCOS via ultrasound, had a history of hirsutism or amenorrhea, followed by subsequent MR imaging. A control group of 35 patients, matched for reproductive age without PCOS diagnosis, hirsutism, amenorrhea, or menstrual irregularities, who underwent MR imaging for any other reason were recruited Results: No significant differences were observed between the groups in terms of age, gravidity, parity, abortions, except for weight and Body Mass Index (BMI). Comparison of MR pelvimetry results between the groups, including pelvic inlet transverse diameter (cm), interspinous diameter (cm), midsagittal pelvic inlet anteroposterior diameter (cm), and midsagittal pelvic outlet anteroposterior diameter (cm), revealed no significant differences. Conclusion: Unfortunatelly, the results did not provide convincing evidence to prove our hypothesis. If it were, we believe, it would provide a bridge between the animal expriments and clinical studies regarding the ethiplogy of PCOS.Öğe Female sexual function outcomes in patients operated for pelvic floor dysfunction: Comparison of synthetic mesh with native tissue repair(2023) Akar, Bertan; Köle, Emre; Karagün, Gaye; Aslan, Erdoğan; Çalışkan, ErayObjectives: We aimed to evaluate the impact of urogynecologic mesh implantations on sexual function using female sexual function index (FSFI) questionnaire Materials and Methods: In this cross-sectional retrospective study, a total of 187 patients which found to have pelvic organ prolapse or stress urinary incontinence (SUI) surgery were investigated between 2015 and 2022. Patients whose main complaint was SUI and had tension free vaginal tape operation (n=21) or transobturator tape operation (n=17) constituted the “Midurethral mesh group” (n=38). Those who had cystocele repair with double obturator trapezoid mesh formed the “Cystocele repair with mesh’’ group (n=35). Patients who had cystocele repair with natural tissue repair without any mesh implant in the vagina or elsewhere in the pelvis constituted the “Natural tissue repair’’ group (n=79). The patients were informed about the study and their consent was obtained. Results: The mean time elapsed since surgery till FSFI measurement was 32±6.5 months in Midurethral Mesh group; 34±7.1 months in the “Cystocele repair with mesh group and 33±7 months in the natural tissue repair group (p>0.05). Total FSFI scores 22.8±6.8, 22.2±7.5, 22.5±7.9 and the frequency of patient with scores lower than 26.5, which is the cut-off for disfunction, was 27 (71.1%), 20 (57.1%) and 47 (59.5%) similar in the three groups (p>0.05). The FSFI subdomain scores such as desire, arousal, lubrication, orgasm, satisfaction, pain was similar in the three groups (p>0.05 for all comparisons). Discussion: Our study demonstrated that surgical repair of symptomatic pelvic organ prolapse and SUI surgery using mesh implants or natural tissue repair had similar results of major parameters of sexual function after surgery.Öğe hCG Administration in Luteal Rescue: Intracavitary or Subcutaneously in Agonist Induced Ovulation in IVF Cycles(2023) Aksoy, Lale; Doğer, Emek; Köle, Merve Çakır; Köle, Emre; Aksoy, Hale; Aslan, Erdoğanresult in the cancellation of the cycle and be fatal in 3 women out of 100,000. The aim of this study is to compare the admission of human chorionic gonadotropin (hCG) subcutaneously versus intracavitary during ovum pick-up (OPU) in agonist induced ovulation in IVF cycles in terms of pregnancy outcomes. Methods: This study was carried out in Kocaeli University Faculty of Medicine, Department of Obstetrics and Gynecology Assisted Reproductive Techniques Clinic as a retrospective study. 157 patients who underwent IVF treatment between January 2018 and February 2020, with ?25 follicles detected in ultrasound and 1 mg of triptorelin acetate was administered for ovulation trigger, and 36 hours later of whom ?20 oocytes were obtained in OPU were enrolled in this study. 109 patients who were administered 1500 IU of hCG subcutaneously belonged to Group 1, and 1500 IU hCG was administered intracavitary to 48 patients as Group 2. Results: Infertility causes, and characteristics of both groups were similar. Number of retrieved oocytes, Metaphase 2 (MII) oocytes and fertilization rates were similar in both groups. Implantation rate per embryo transferred was higher in the intracavitary group (p = 0.01). There was no significant difference for pregnancy rate, clinical pregnancy rate, ongoing pregnancy rate, livebirth rate and OHSS frequency between both groups. Twin pregnancy rate was significantly higher in the intracavitary group. Conclusions: Administration of 1500 IU hCG intracavitary at the time of OPU is associated with improved implantation rates when compared to subcutaneous hCG administration without a significant raise in OHSS occurrence. Prospective, randomized studies with bigger patient cohort are needed. © 2023 The Author(s).Öğe Health Literacy and Prenatal Care: Generalizability and Methodological Considerations(2024) Ardahanli, Nesrin; Köle, EmreIn this letter to Şahin et al.'s article titled \"Assessment of Relationship Between Health Literacy and Level of Knowledge on Prenatal Diagnosis and Antenatal Care in Pregnant Women,\" the authors critically evaluate some aspects of the study methodology. In particular, the study's single-center design and the sample's homogeneous structure in terms of socioeconomic and educational levels limit the generalizability of the findings. It is also emphasized that more information should be provided on the psychometric properties of the health literacy scale and that longitudinal studies should be designed to investigate causality.Öğe Hymenoplasty Experience: Factors Associated with Dehiscence (Hymenoplasty Complications)(2025) Cömert, Erhan; Köle, Emre; Saraç, Ömer Doğukan; Doğan, Ozan; Caliskan, ErayPurpose: To evaluate outcome of hymenoplasties in private clinics and investigate the factors affecting the risk of dehiscence Method: A retrospective cross-sectional survey of Obstetrics and Gynecology specialists trained over the last five years was conducted. Specialists from private clinics completed surveys on hymenoplasties performed. Rates and types of complications were requested and factors associated with wound dehiscence in patients undergoing permanent hymenoplasty was investigated with multivariate analysis. Results:. A total of 968 patients were included. Hymenoplasty was performed for revirgination in 874 cases (90.2%), incision of the hymen for gynecological procedures in 82 (8.4%) cases and trauma in 12 cases (1.2%). Complications included wound dehiscence (26.1%), infection (1.7%), bleeding (1.7%), pain (1.5%), itching (1.4%) and dyspareunia (0.5%). The technique was permanent in 714 cases and temporary in 254 cases. Among the permanent hymenoplaty cases, multivariate logistic regression analysis showed that obesity (OR=3.1, 95%CI: 1.5-6.2, p=0.001) and tobacco use (OR=2.2, 95%CI: 1.3-3.8, p=0.003) increases the risk of dehiscence. Sedation decreased the risk of dehiscence when compared to local infiltration anesthesia (OR=0.56, 95%CI: 0.33-0.99, p=0.04). Every decrease in the polyglactin suture caliber decreased the risk of dehiscence (OR=0.22, 95%CI: 0.16-0.3, p<0.001) This study showed that using 5.0 sutures, omitting infiltration anesthesia, and avoiding tobacco use may help decrease wound dehiscence after hymenoplasty.Öğe Importance of Structural Abnormalities Detected by Array-Comparative Genomic Hybridization in Recurrent Miscarriage: A retrospective Study(Aydin Adnan Menderes University, 2023) Akar, Bertan; Köle, Emre; Akkoyunlu, Deniz Sünnetçi; Köle, Merve Çakır; Çine, Naci; Savlı, Hakan; Çalışkan, ErayObjective: Chromosomal anomalies are among the most important risk factors of recurrent miscarriage. In 5.5% of the cases, one of the parents has cytogenetic anomaly in contrast to 0.55% of the general population. Recent literature data have used a?CGH for detection of cause of abortion, but there are few studies specifically conducted to evaluate the correlation of chromosomal rearrangement and recurrent miscarriages; yet there is no clear evidence on this issue. In this study, we aimed on the correlation of chromosomal rearrangement in couples with unexplained recurrent miscarriage by a-CGH. Methods: The karyotyping and aCGH data of 74 patients with more than five abortions were analyzed retrospectively. Cell cultures, harvesting, and G-banding at the level of 400-550 bands for karyotyping were performed following standardized procedures. The extracted maternal or paternal DNA concentration and quality were measured with the spectrophotometer and gel electrophoresis, respectively. Results: A total of 74 patients, 50 women with male partners of 24 were included in the study. The results of a-CGH were normal for 22 males (91.7%) and 46 females (92%) and the distribution of the normal patients were not significant between the genders when patients with duplication and deletion anomalies (Duplication: 4q12, 2(p15-p14), 17q12; Deletion: 1(q21.1-q21.2), 16p11.2, Xp22.31) were compared (p > 0.05). Conclusion: The maternal and paternal aCGH analysis yielded low rate of duplication and deletion anomalies of the chromosomes. The clinical significance of the yielded abnormalities need to be evaluated for patient consultation.Öğe KALİTELİ EMBRİYO TRANSFERİNE RAĞMEN BAŞARISIZ IVF SİKLUSU OLAN KADINLARDA İN VİTRO FERTİLİZASYON (IVF) TEDAVİSİ BOYUNCA İV LİPİD (SMOFLIPID®) KULLANIMININ ETKİSİ: VAKA KONTROL ÇALIŞMASI(Kocaeli Üniversitesi, 2022) Akar, Bertan; Doğan, Ozan; Köle, Emre; Çalışkan, ErayAmaç: Tekrarlayan implantasyon başarısızlığı (RIF) zorlu bir gerçek olduğundan, bu sorunun üstesinden gelmek için farklı terapötik immünomodülatör ajanların etkileri araştırılmaktadır. Bu çalışma, intralipidin RIF'li IVF hastalarının gebelik sonuçları üzerindeki etkisini değerlendirmeyi amaçlamıştır. Yöntemler: Katılımcıların 116'sı sadece kısa antagonist protokolünü alan kontrol grubuna, 106'sı ise intravenöz lipid (SMOFlipid®) verilerek intralipid grubunda yer aldı. İntralipid, embriyo transferinin olduğu gün, pozitif gebelik testinin olduğu gün verildi ve gebeliğin onuncu haftasına kadar haftalık olarak devam edildi. İmplantasyon oranı, biyokimyasal gebelik oranı, klinik gebelik oranı ve canlı doğum oranı değerlendirildi. Bulgular: Pozitif gebelik testi, klinik gebelik oranı ve canlı doğum oranı İntralipid grubunda istatistiksel olarak anlamlıydı (pÖğe Kovid-19 Pandemisinden Öğrenilen Dersler: Hayatı Tehdit Eden Bir Dönemde Gebelik Kaygı Düzeyi Artıyor(Alanya Alaaddin Keykubat Üniversitesi, 2023) Köle, Emre; Aksoy, Lale; Görgülü, Gökşen; Demir, Hakan; Köle, Merve Çakır; Aslan, ErdoğanAmaç: Bu çalışmada, COVID-19 enfeksiyonlu hamile kadınlardaki epidemiyolojik verilerle birlikte, pandemi sürecinde hastalığın oluşturduğu psikolojik etkileri ve pandemide artan anksiyetenin gebelik sonuçlarına etkilerini vurgulamayı amaçladık. Materyal ve Yöntemler: Bu çalışma,15 ila 49 yaşlarındaki 100 kadında gerçekleştirildi ve katılımcılar, Kadın Hastalıkları ve Doğum Polikliniği, Pandemi Polikliniği ve Gebelik Polikliniği'ne başvuranlardan seçildi. Kırk altı COVID-19 pozitif gebe kadın, kontrol grubu olarak negatif COVID-19 PCR testi olanlarla karşılaştırıldı. Katılımcılara bir anket ve Beck Anksiyete Envanteri uygulandı. Bulgular: Beck Anksiyete Envanteri kullanılarak yapılan bu çalışmada COVID-19 pozitif gebe grubunda anksiyete düzeylerinin COVID-19 negatif gebe grubuyla karşılaştırıldığında anlamlı derecede yüksek olduğunu gösterildi (p=0.001). Gruplar, pandemi sırasında gebe kalma ve doğum yapma açısından karşılaştırıldığında, "şiddetli anksiyete" nin COVID-19 negatif hamile grubunda anlamlı derecede arttığı bulundu (p=0.032). Sonuç: Beck Anksiyete Envanterine dayalı olarak, COVID-19 pozitif olanların negatif gruplarla karşılaştırıldığında gebelik sırasında anksiyete düzeylerini anlamlı derecede artırdığını tespit ettik.Öğe Obstetric hemorrhage and surgical emergencies training workshops on fresh cadavers and simulators result in high application in daily practices and decreased patient referral(2022) Akar, Bertan; Ceylan, Yasin; Kahraman, Alper; Köle, Emre; Çalışkan, ErayObjective: In this study, we aimed to evaluate the effects of obstetric emergencies workshops combining theoretical lectures, simulation trainers and fresh cadaver models on daily practices and referrals of obstetrics and gynecology specialists. Materials and Methods: This is a prospective observational study involving obstetrics and gynecology specialists attending the Turkish Society of Obstetrics and Gynecology endorsed obstetrics hemorrhage management courses held in 2018 and 2019. The training course is an annually organized two-day course, one day allotted to theoretical lectures and the other day to practical training on both simulators and fresh cadavers. Trainees participating in the course was surveyed with an anonymous questionnaire on their motivation to attend the course and their juridical history of obstetric patient management. Attendees were asked to disclose whether they had ever independently performed the procedures stated in the questionnaire or not, before commencing the course and 1 year after attending the course. Results: Among the attendees 22% (n=32) had at least one obstetrical malpractice lawsuit and 36.1% (n=52) were accused of Health Care Complaints Comission. The main motivation of the attendees for taking this course was Professional development followed by reducing maternal mortality and morbidity and avoiding malpractice. One year after the course, attendees applying uterine devascularization surgery increased by 36.1% (52/144), uterine compression sutures increased by 52.7% (76/144), and ability to apply uterine balloon tamponade increased by 59.7% (86/144). Besides improvement in other obstetric surgical skills an indirect effect seen that the attandees operated on high-risk cases increased in placenta previa (15.3%), placenta acreata spectrum (30.5%), operative deliveries (27.7%), peripartum hysterectomy (24.9%) and relaparotomy for postpartum hemorrhage (34.7%). Conclusion: Opportunities of attending well organized fresh cadaveric workshops on managing postpartum hemorrhage and other obstetric surgeries, can quickly adapt to daily practice, restore the professional confidence of obstetric and gynecology specialists, and eventually decrease patient referral.Öğe OP-14 Fetal right ventricular diverticulum a case report(2023) Güllüoğlu, Ahmet; Deniz, Alparslan; Köle, Emre; Çalışkan, Eray; Hasanova, İlahaAim We report the case of 27 years old age Turkish lady G2 P1 at 20 weeks of gestations, double test was normal, attended for routine prenatal ultrasound screening a four chamber ultrasound of the heart with right ventricular diverticulum associated with pericardial effusion. Case A 27 years old age woman at 20 weeks of gestation, came for routine second trimester ultrasound screening. Ultrasound revealed four chambers of the heart with right ventricular outpouching (right ventricular diverticula or aneurysm) associated with pericardial effusion, no other anomalies. She was explained about the ultrasound findings and referred to pediatrics cardiology, fetal cardiac echo was done, confirmed the ultrasound findings and the diagnosis of fetal right ventricular diverticulum with pericardial effusion with no other cardiac malformations. She was followed up by ultrasound at 22 weeks of gestations, which revealed same findings but the pericardial effusion increased. Follow up ultrasound at 24 weeks of gestations the fetus was intrauterine death. Discussion By reviewing literature the overall prenatal prognosis of ventricular diverticula is favorable even if associated with pericardial effusion, hence conservative management may be a reasonable option, unless there is risk of impending rupture, cardiac temponade or significant lung compression and subsequently pulmonary hypoplasia. Our case was with right ventricular diverticulum and pericardial effusion and no other cardiac malformations and the choice of conservative management was opted but the fetus died at 24 weeks of gestation. Among the therapeutic options fetal pericardiocentesis to decompress the fetal thorax to allow lung expansion and reduction of systemic venous pressure leading to reduction in the risk of pulmonary hypoplasia but the risk is considered too high especially in isolated ventricular diverticulum with pericardial effusion as pulmonary hypoplasia usually resolve with corticosteroid therapy and pericardial effusion disappears progressively in most of the cases. Conclusion The prognosis is good in isolated cases. The 10 years survival rate for the patients with ventricular diverticula is approximately 80% while the 4 years survival rate for patients with congenital ventricular anuerysm is approximately 30%. However complications include rupture, arrhythmia, thrombus formation, heart failure and infective endocarditis, therefore, monitoring is required.Öğe The Effect of Prognostic Factors on Survival in Endometrioid Type Adenocancer(2023) Baştan, Merve; Kole, Merve Cakir; Aksoy, Lale; Köle, Emre; Çorakçı, AydınObjective: The study aims to investigate the prognostic factors in uterine endometrioid adenocarcinoma that affect survival outcomes. Materials and Methods: This retrospective study includes 144 cases which underwent surgical treatment for uterine endometrioid adenocarcinoma. Demographic data and tumour characteristics were evaluated for lymph node metastasis. Stage I and grade 1-2 tumours were divided into lymphadenectomy and non-lymphadenectomy groups, and 5-year survival was assessed. Results: The presence of myometrial invasion of more than 1/2, adnexal metastasis and lymphovascular space invasion were found to be associated with lymph node metastasis (p=0.010 ve 0.019 ve 0.015). In our study, the 5-year survival rate was 87.4%. Survival rate was correlated with age, myometrial invasion, and tumour grade. The 5-year survival rates were 89.8% in lymphadenectomy group and 85.2% in non-lymphadenectomy group, and no statistically significant difference was observed (p=0.575). Conclusion: Myometrial invasion, grade and the age of diagnosis were detected as important prognostic factors of uterine endometrioid adenocarcinomas. We concluded that lymphadenectomy did not increase the survival rate of stage I grade 1-2 endometrioid tumours. Lymphadenectomy may not be performed in stage I grade 1-2 tumours; thus, the morbidities of lymphadenectomy can be avoided.
