Browsing by Author "Kale, Ahmet"

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Comparison of Ultrasound-Guided Transgluteal and Finger-Guided Transvaginal Pudendal Nerve Block Techniques: Which One is More Effective?
(KOREAN CONTINENCE SOC, 2019-01-01) Kale, Ahmet; Usta, Taner; Basol, Gulfem; Cam, Isa; Yavuz, Melike; Aytuluk, Hande G.
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.
Evaluation of the surgical outcome and complications of total laparoscopic hysterectomy in patients with enlarged uteruses
(ELSEVIER SCIENCE BV, 2016-01-01) Terzi, Hasan; Hasdemir, Pinar Solmaz; Biler, Alper; Kale, Ahmet; Sendag, Fatih
Objective: The aim of this study was to investigate whether uterine weight has a deleterious effect on the operation time, complication rates, length of hospital stay and incidence of intraoperative haemorrhage during total laparoscopic hysterectomy operation. Methods: A total of 282 patients who underwent total laparoscopic hysterectomy for benign gynaecologic indications were retrospectively analyzed. The median operation time of 70 min was accepted as an index number, and a cut-off point of >= 300 g was calculated for uterine weight by using reciever operator characteristics (ROC) curve analysis. Results: There was no statistically significant relationship between the uterine weight and haemoglobin drop rate (1.27 +/- 0.89 vs 1.21 +/- 0.88, p = 0.905), complication rate (10.83\% vs 9.26\%, p = 0.062) and length of hospital stay (3.27 +/- 1.23 vs 3.37 +/- 1.35 days, p = 0.505) based on this cut. Lee-Huang point was preferred for abdominal entry in cases with uteruses reached the level of umbilicus -2 cm in physical examination. Conclusions: Uterine weight was not effected the complication rate, estimated blood loss and length of hospital stay in total laparoscopic hysterectomy operation. A cut-off value of 300 g could be used for an increased operation time. (C) 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.
Intrapelvic Nerve Entrapment Syndrome Caused by a Variation of the Intrapelvic Piriformis Muscle and Abnormal Varicose Vessels: A Case Report
(KOREAN CONTINENCE SOC, 2021-01-01) Kale, Ahmet; Basol, Gulfem; Topcu, Ahmet C.; Gundogdu, Elif C.; Usta, Taner; Demirhan, Recep
Entrapment neuropathy of the sciatic nerve and pudendal nerve are painful syndromes that are often overlooked by physicians. Laparoscopic surgical interventions for nerve entrapment syndromes of the posterior pelvis focus on removing the compression lesion with the purpose of eliminating the suspected cause of sciatica, as well as pudendal neuralgia. Herein, the authors report the rare event of sciatic and pudendal nerve entrapment, which was caused by aberrant vessels and a variant piriformis muscle bundle, as a seldom-diagnosed cause of sciatica and pelvic pain, for both neurosurgeons and neuropelveologists. The authors present the laparoscopic decompression technique for the pudendal and sciatic nerves by giving our technical ``tips and tricks{''} enriched by a surgical video.
Is it safe to perform elective gynaecologic surgery during the two peaks of COVID-19 pandemic?
(WILEY, 2021-01-01) Kuru, Betul; Kale, Ahmet; Basol, Gulfem; Gundogdu, Elif Cansu; Yildiz, Gazi; Mat, Emre; Usta, Taner
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.
Total laparoscopic hysterectomy: Analysis of the surgical learning curve in benign conditions
(ELSEVIER, 2016-01-01) Terzi, Hasan; Biler, Alper; Demirtas, Omer; Guler, Omer Tolga; Peker, Nuri; Kale, Ahmet
Objective: To assess the learning curve for total laparoscopic hysterectomy. Methods: This study was a retrospective analysis of the learning curve for two surgeons during their first 257 consecutive cases of total laparoscopic hysterectomy at a teaching hospital. Patients were divided sequentially into groups comprising the first 75 patients, the next 75, and the final 107 patients. Age, body mass index, gestational parity, indications for laparoscopic hysterectomy, previous pelvic surgery, operating time, haemoglobin decline, complications, need for transfusion, and length of hospital stay were evaluated. Results: The mean operating time for total laparoscopic hysterectomy reduced significantly from 76.2 min to 68.9 min (p = 0.001) between the first and second 75-patient groups. Linear regression analysis showed a plateau was reached on the learning curve after 71-80 cases. The rate of all complications started at 8\% in the first group of 75 patients, reduced to 6.7\% in the next group, and decreased further in the final group to 4.7\%. The decline was not statistically significant (p = 0.6). The difference in the need for transfusion was statistically significant between the first 75 patients and the second group of 75 (p = 0.04). Conversion from laparoscopy to laparotomy was required in five patients, four in the early group and one in the final group. Age, body mass index, parity, previous pelvic surgery, decline in haemoglobin, and length of hospital stay were similar among the three groups. Conclusions: A plateau in the learning curve for TLH was reached after the first 75 cases. We can infer that there is a learning curve for TLH as confirmed by the decrease in operating time (accompanied by no change in complications) correlated to gain in experience. On the other hand, one should not disregard the fact that laparoscopy is not a complication-free surgery and achievement of the learning curve does not exclude complications. Gynaecological surgeons can perform TLH securely during the learning curve. (C) 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.