Araştırma Çıktıları

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    Receptivity-based uterine fibroid surgery: an updated systematic review of the evidence
    (IMR PRESS, 2022-01-01) Celik, Onder; Koc, Onder; Yurci, Arzu; Ersahin, Aynur; Celik, Nilufer; Tanilir, Fatma; Gurkan, Naziye; Ozyurt, Ramazan; Ozcil, Mustafa Dogan; Duran, Bulent; Unlu, Cihat
    Background: Analyzing expression patterns of receptivity genes is a minimally invasive diagnostic method to identify the underlying cause of subfertility in women with uterine fibroid with a history of implantation failure or recurrent pregnancy loss. This updated systematic review was designed to determine the molecular and genetic changes in the endometrium of women with fibroid and how myomctomy affect the outcome of spontaneous or assisted conception treatment. We also discussed the extent to which we should consider the effects of fibroids on endometrial receptivity when deciding whether or not to perform myomectomy. Methods: A total of 184 articles reached as a result of PubMed research and meeting the selection criteria, were evaluated. Of these, 28 full text articles on uterine leiomyoma and endometrium, leiomyoma and receptivity, fibroid and implantation, myomectomy and implantation, fibroid and genes, fibroid surgery and receptivity, fibroid and uterine peristalsis, fibroid and immune cell were evaluated. Results: The endometrium of subfertile women with fibroid appears to have a disease specific pattern according to the type of the fibroid. The response of the endometrium to a fibroid may vary depending on whether the fibroid is close or far from it. Leiomyomas that contribute to subfertility must be near to or in contact with the endometrium, as is the case for Types 0, 1 and 2 leiomyomas. The proximity to the endometrial cavity makes the effect of fibroid on the endometrium more pronounced. While Type 3 fibroid causes subfertility similar to submucosal fibroids, the subfertility-producing effects of Type 4 fibroids have not been clearly clarified. However, the fact that the fibroid is far from the cavity should not mean that it has no effect on the endometrium. The mechanical stress created by a Type 4 fibroid that is not connected to the endometrium may be converted into biological signal and disrupt receptivity. Data on whether myomectomy restores impaired receptivity are mostly based on clinical observations, and studies evaluating endometrial receptivity before and after myomectomy are very few. Conclusions: Analysis of receptivity genes in subfertile women with fibroid may assist the clinician in deciding whether or not to perform myomectomy. If it is determined whether fibroids affect receptivity other than their mechanical effects, the indications for myomectomy may expand or narrow.
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    Comparison of perioperative outcomes among robot-assisted, conventional laparoscopic, and abdominal/open myomectomies
    (GALENOS YAYINCILIK, 2021-01-01) Ozbasli, Esra; Gungor, Mete
    Objective: To compare the perioperative results of myomectomy performed by robotic surgery (RM), laparoscopic surgery (LM), and open/abdominal surgery (OM). Material and Methods: We included 227 patients who underwent either robotic (n=66), laparoscopic (n=88), or abdominal (n=73) myomectomy at our hospital between 2016 and 2020. Retrospective medical records, including fibroid characteristics, demographic findings, and surgical outcomes, were compared. Results: The RM group had a significantly lower body mass index and significantly larger uterine size, myoma diameter, and myoma weight than the other groups. However, the OM group had the highest number of myoma. Moreover, the RM group had higher operative time and blood loss but significantly lower maximum visual analog scale values than the OM and LM groups. Hospitalization duration was significantly different among the groups. The rate of 1-day hospitalization was 56.2\%, 64.8\%, and 37.9\% in the OM, LM, and RM groups, respectively. Furthermore, blood transfusion requirement was significantly higher in the OM group (12.3\%) than in the LM and RM groups (0.0\% and 4.5\%, respectively). Conclusion: Minimally invasive myomectomy may be preferable, particularly for women of reproductive age. In women with large uterine size and myoma, robot-assisted LM is recommended.