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Item Could the Long-Term Oncological Safety of Laparoscopic Surgery in Low-Risk Endometrial Cancer also Be Valid for the High-Intermediate- and High-Risk Patients? A Multi-Center Turkish Gynecologic Oncology Group Study Conducted with 2745 Endometrial Cancer Cases. (TRSGO-End-001)(MDPI, 2021-01-01) Vardar, Mehmet Ali; Guzel, Ahmet Baris; Taskin, Salih; Gungor, Mete; Ozgul, Nejat; Salman, Coskun; Kucukgoz-Gulec, Umran; Khatib, Ghanim; Taskiran, Cagatay; Duender, Ilkkan; Ortac, Firat; Yuce, Kunter; Terek, Cosan; Simsek, Tayup; Ozsaran, Aydin; Onan, Anil; Coban, Gonca; Topuz, Samet; Demirkiran, Fuat; Takmaz, Ozguc; Kose, M. Faruk; Gocmen, Ahmet; Seydaoglu, Gulsah; Gumurdulu, Derya; Ayhan, AliThis study was conducted to compare the long-term oncological outcomes of laparotomy and laparoscopic surgeries in endometrial cancer under the light of the 2016 ESMO-ESGO-ESTRO risk classification system, with particular focus on the high-intermediate- and high-risk categories. Using multicentric databases between January 2005 and January 2016, disease-free and overall survivals of 2745 endometrial cancer cases were compared according to the surgery route (laparotomy vs. laparoscopy). The high-intermediate- and high-risk patients were defined with respect to the 2016 ESMO-ESGO-ESTRO risk classification system, and they were analyzed with respect to differences in survival rates. Of the 2745 patients, 1743 (63.5\%) were operated by laparotomy, and the remaining were operated with laparoscopy. The total numbers of high-intermediate- and high-risk endometrial cancer cases were 734 (45\%) patients in the laparotomy group and 307 (30.7\%) patients in the laparoscopy group. Disease-free and overall survivals were not statistically different when compared between laparoscopy and laparotomy groups in terms of low-, intermediate-, high-intermediate- and high-risk endometrial cancer. In conclusion, regardless of the endometrial cancer risk category, long-term oncological outcomes of the laparoscopic approach were found to be comparable to those treated with laparotomy. Our results are encouraging to consider laparoscopic surgery for high-intermediate- and high-risk endometrial cancer cases.Item Sentinel lymph node biopsy in early stage endometrial cancer: a Turkish gynecologic oncology group study (TRSGO-SLN-001)(BMJ PUBLISHING GROUP, 2020-01-01) Taskin, Salih; Altin, Duygu; Vatansever, Dogan; Tokgozoglu, Nedim; Karabuk, Emine; Turan, Hasan; Takmaz, Ozguc; Kahramanoglu, Ilker; Naki, Mehmet Murat; Gungor, Mete; Kose, Faruk; Ortac, Firat; Arvas, Macit; Ayhan, Ali; Taskiran, CagatayObjective The aim of this multicenter study was to evaluate the feasibility of sentinel lymph node (SLN) mapping in clinically uterine confined endometrial cancer. Methods Patients who underwent primary surgery for endometrial cancer with an SLN algorithm were reviewed. Indocyanine green or blue dye was used as a tracer. SLNs and/or suspicious lymph nodes were resected. Side specific lymphadenectomy was performed when mapping was unsuccessful. SLNs were ultrastaged on final pathology. Results 357 eligible patients were analyzed. Median age was 59 years. Median number of resected SLNs was 2 (range 1-12) per patient. Minimal invasive and open surgeries were performed in 264 (73.9\%) and 93 (26.1\%) patients, respectively. Indocyanine green was used in 231 (64.7\%) and blue dye in 126 (35.3\%) patients. The dyes were injected into the cervix in 355 (99.4\%) patients. The overall and bilateral SLN detection rates were 91.9\% and 71.4\%, respectively. The mapping rates using indocyanine green or blue dye were comparable (P=0.526). There were 43 (12\%) patients with lymphatic metastasis. The SLN algorithm was not able to detect 3 of 43 patients who had isolated paraaortic metastasis. After SLN biopsy, complete pelvic lymphadenectomy was performed in 286 (80.1\%) patients. Sensitivity and negative predictive value were both 100\% for the detection of pelvic lymph node metastases. In addition, 117 (32.8\%) patients underwent completion paraaortic lymphadenectomy after SLN biopsy. In these patients, sensitivity for detecting metastases to pelvic and/or paraaortic lymph nodes was 90.3\% with a negative predictive value of 96.6\%. The risk of non-SLN involvement in patients with macrometastatic SLNs, micrometastatic SLNs, and isolated tumor cells in SLNs were 61.2\%, 14.3\% and 0\%, respectively. Conclusions SLN biopsy had good accuracy in detecting lymphatic metastasis. However, one-third of cases with metastatic SLNs also had non-SLN involvement and this risk increased to two-thirds of cases with macrometastatic SLNs. The effect of leaving these nodes in situ on survival should be evaluated in further studies.Item Can follicular Emmprin and BMP 4 levels predict ICSI outcome?(SPRINGER/PLENUM PUBLISHERS, 2019-01-01) Takmaz, Ozguc; Yozgatli, Dilara; Ozaltin, Selin; Ozbasli, Esra; Kocyigit, Yucel; Kuran, Sibel Bulgurcuoglu; Bulut, Huri; Gungor, Mete; Buyru, Faruk; Bastu, ErcanPurposeTo evaluate the relationship of clinical pregnancy rates with bone morphogenetic proteins 2-4-7 (BMP 2, 4, 7), growth differentiation factor 9 (GDF 9), and Emmprin levels in follicular fluid of intracytoplasmic sperm injection patients.MethodsFollicular fluid of 77 patients who underwent ICSI procedure was collected during the oocyte retrieval procedure. And follicular fluid levels of BMP 2, BMP 4, BMP 7, GDF 9, and Emmprin (Basigin) were measured and compared for clinical pregnancy rates.ResultsFollicular levels of BMP 4 was significantly higher whereas Emmprin levels were lower in patients who had achieved clinically diagnosed pregnancy compared with those who did not achieve clinical pregnancy after ICSI procedure (P=0.007 and P=0.035, respectively). BMP 2, BMP 7, and GDF 9 levels were comparable for both groups.ConclusionClinical pregnancy rates after ICSI may be associated with follicular fluid levels of Emmprin and BMP 4. Follicular levels of Emmprin and BMP 4 can be used as a marker (as markers for predicting ICSI outcomes) for a better ICSI outcome.Item Is Endometrial Receptivity Assay (ERA) Useful in Patients with Repeated Implantation Failure Undergoing Single, Autologous Euploid Embryo Transfer?(IMR PRESS, 2022-01-01) Ozaltin, Selin; Celik, Hale Goksever; Takmaz, Ozguc; Yagmur, Erbil; Ozbasli, Esra; Gungor, Mete; Yeh, John; Bastu, ErcanBackground: Our aim in this study was to evaluate whether endometrial receptivity assay (ERA) test improves single, autologous euploid frozen-thawed embryo transfer (FET) outcomes in patients with repeated implantation failure. Methods: This was a retrospective cohort study which was conducted in a University affiliated private hospital. The study included 135 patients with repeated implantation failure who underwent single, autologous euploid ERA adjusted and non-adjusted FET. Patients were stratified into three groups, patients with receptive endometrium based on the ERA test, patients with non-receptive endometrium based on the ERA test and patients who did not receive the ERA test (control group). The three groups were compared in terms of FET outcomes. Results: Of 135 patients, 73 had the ERA test results available and 62 did not have the ERA test. Of 73 patients, 28 had non-receptive endometrium and 45 had receptive endometrium. The three groups are all the same in terms of age, body mass index, type of infertility, duration of infertility, number of previously embryo transfers and infertility causes (p > 0.05). Live birth rates were 46\%, 50\% and 51\% for receptive, nonreceptive and control groups, respectively (p > 0.05). Implantation and clinical pregnancy rates were similar between the groups, as well. Conclusions: Adjusting the embryo transfer day according to the ERA test results seems to improve FET outcomes in patients with repeated implantation failure.Item Morcellation in gynecology: short review and suggestions from Turkish Society of Minimally Invasive Gynecologic Oncology(GALENOS YAYINCILIK, 2021-01-01) Taskin, Salih; Varli, Bulut; Yalcin, Ibrahim; Ortac, Firat; Taskiran, Cagatay; Gungor, MeteMorcellation allows the removal of a large uterus and fibroids through small incisions with minimally invasive surgery. It helps to prevent the complications associated with large incisions in both hysterectomy and myomectomy operations. Currently, there is much debate regarding the use of power morcellation in laparoscopic hysterectomy and myomectomy, mainly due to the risk of peritoneal dissemination of undiagnosed uterine sarcomas. Unfortunately, there is no valid pre-operative diagnostic method that can differentiate sarcomas from myomas, and the currently available scientific literature regarding morcellation is insufficient. As the Turkish Society of Minimally Invasive Gynecological Oncology, we present our consensus opinion and suggestions for the preoperative evaluation and morcellation of fibroids, in line with the recent literature.Item Lymph node dissection in atypical endometrial hyperplasia(GALENOS YAYINCILIK, 2017-01-01) Taskin, Salih; Kan, Ozgur; Dai, Omer; Taskin, Elif A.; Koyuncu, Kazibe; Alkilic, Aysegul; Gungor, Mete; Ortac, FiratObjective: The rate of concomitant endometrial carcinoma in patients with atypical endometrial hyperplasia is high. We aimed to investigate the role of lymphadenectomy in deciding adjuvant treatment in patients with concomitant atypical endometrial hyperplasia and endometrial carcinoma. Material and Methods: Women with atypical endometrial hyperplasia were enrolled in this retrospective study. Lymph node dissection was performed in only some patients who gave informed consent if their surgeon elected to do so, or if the intraoperative findings necessitated. The final histopathologic evaluations of surgical specimens were compared with endometrial biopsy results. Results: Eighty eligible patients were evaluated. Seventy-two (90\%) patients had complex hyperplasia with atypia, and 8 (10\%) patients had simple hyperplasia with atypia. Hysterectomy and bilateral salpingo-oophorectomy were performed to all patientsItem Severe acute respiratory syndrome coronavirus (SARS-CoV-2) is not detected in the vagina: A prospective study(PUBLIC LIBRARY SCIENCE, 2021-01-01) Takmaz, Ozguc; Kaya, Eren; Erdi, Burak; Unsal, Gozde; Sharifli, Pari; Agaoglu, Nihat Bugra; Ozbasli, Esra; Gencer, Serap; Gungor, MeteObjective To determine whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is present in the vagina of women diagnosed with coronavirus disease-19 (COVID-19) pneumonia. Study design The study was conducted prospectively in a university affiliated hospital. Forty-one women of reproductive age whose nasopharyngeal PCR test were positive for SARS-CoV-2 and clinically diagnosed with pneumonia were included in the study. Vaginal swabs were obtained for SARS-CoV-2 PCR tests when the patients were admitted to the inpatient service before pneumonia treatment was initiated. Results Vaginal swab samples of 38 patients were analysed with SARS-CoV-2 PCR tests. None of the vaginal swabs were positive for SARS-CoV-2. Conclusions SARS-CoV-2 does not infect the vagina of women diagnosed with SARS-CoV-2 pneumonia.Item Studying Brain Activation during Skill Acquisition via Robot-Assisted Surgery Training(MDPI, 2021-01-01) Izzetoglu, Kurtulus; Aksoy, Mehmet Emin; Agrali, Atahan; Kitapcioglu, Dilek; Gungor, Mete; Simsek, AysunRobot-assisted surgery systems are a recent breakthrough in minimally invasive surgeries, offering numerous benefits to both patients and surgeons including, but not limited to, greater visualization of the operation site, greater precision during operation and shorter hospitalization times. Training on robot-assisted surgery (RAS) systems begins with the use of high-fidelity simulators. Hence, the increasing demand of employing RAS systems has led to a rise in using RAS simulators to train medical doctors. The aim of this study was to investigate the brain activity changes elicited during the skill acquisition of resident surgeons by measuring hemodynamic changes from the prefrontal cortex area via a neuroimaging sensor, namely, functional near-infrared spectroscopy (fNIRS). Twenty-four participants, who are resident medical doctors affiliated with different surgery departments, underwent an RAS simulator training during this study and completed the sponge suturing tasks at three different difficulty levels in two consecutive sessions/blocks. The results reveal that cortical oxygenation changes in the prefrontal cortex were significantly lower during the second training session (Block 2) compared to the initial training session (Block 1) (p < 0.05).Item Laparoscopic near-infrared fluorescent imaging as an alternative option for sentinel lymph node mapping in endometrial cancer: A prospective study(ELSEVIER SCIENCE BV, 2017-01-01) Taskin, Salih; Sukur, Yavuz Emre; Altin, Duygu; Ersoz, Cevriye Cansiz; Turgay, Batuhan; Kankaya, Duygu; Gungor, Mete; Ortac, FiratBackground: To evaluate feasibility of sentinel lymph node (SLN) mapping by using near-infrared fluorescent imaging and indocyanine green (NIR/ICG) integrated laparoscopic system in clinically uterine-confined endometrial cancer. Materials and methods: Patients with clinically early-stage endometrial cancer were included in this prospective study. ICG was injected to the uterine cervix and NIR/ICG integrated laparoscopic system (Spies Full HD D-Light P ICG technology, Karl Storz, Tuttlingen, Germany) was used during the operations. SLN and/or suspicious lymph nodes were resected. Side specific lymphadenectomy was performed when mapping was unsuccessful. Systematic lymphadenectomy was completed following SLN algorithm steps. Results: Seventy-one eligible patients were analyzed. The overall, unilateral and bilateral SLN detection rates were 95.7\%, 18.3\%, 77.4\%, respectively. There were 8 (11.2\%) patients with lymph node metastasis. One of them was isolated para-aortic node metastasis. Negative predictive value, sensitivity and false negative rate for detecting lymphatic spread were 98.4\%, 87.5\% and 1.5\%, respectively. Conclusion: Sentinel lymph node mapping can easily be performed with high accuracy by using NIR/ICG integrated conventional laparoscopic system in endometrial cancer and almost all lymphatic spread can be detected. (C) 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.Item Labor Induction with Intravaginal Misoprostol versus Spontaneous Labor: Maternal and Neonatal Outcomes(HINDAWI LTD, 2022-01-01) Ozbasli, Esra; Canturk, Melis; Aygun, Elif Ganime; Ozaltin, Selin; Gungor, MetePurpose. To compare the maternal and neonatal outcomes of pregnant women who had labor induction with intravaginal misoprostol or had spontaneous labor in our clinic. Material-Method. The records of 213 pregnant women, who were followed up in Acibadem Maslak University Hospital for vaginal delivery between June 2021 and December 2021, were retrospectively evaluated. The pregnant women, who gave birth, were divided into 3 groups as follows: spontaneous labor (SL), those induced by a single dose of misoprostol (SDM), and those induced by multiple doses of misoprostol (MDM). The groups were compared in terms of delivery type, the vaginal birth rate within 12 hours, need for intervention, duration of the second stage of labor, cesarean section ratio due to fetal distress, time from the last dose to delivery, and 1st and 5th minute APGAR scores. Results. Among the primiparous pregnant women, 84.7\% of SL group, 65.2\% of SDM group, and 37\% MDM group delivered vaginally within 12 hours (p < 0.05). The time from the last misoprostol dose to delivery was also statistically significantly shorter in pregnant women, who received a single dose of misoprostol (483 vs. 720 min, respectively). When the hospitalization time was evaluated, in the SDM group, the MDM group, and the SL group, it was found to be 611, 831, and 379 min, respectively. In multiparous pregnant women, the hospitalization time was 735 min in the SDM group, 494 min in the MDM group, and 261.5 min in the SL group (p < 0.05). Other than the hospitalization time, when the aforementioned variables were studied in multiparous pregnant women, no statistically significant difference among groups was observed (p > 0.05). Conclusion. Intravaginal misoprostol seems to be a promising medical agent for labor induction due to its high delivery rates within 12 hours and the absence of negative fetal outcomes, its ease of storage, and affordable cost.