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Öğe Comparison of pain and proper sample status according to usage of tenaculum and analgesia: A randomized clinical trial(Korean Society of Obstetrics and Gynecology, 2020) Comba, Cihan; Demirayak, Gökhan; Erdoğan, Şakir Volkan; Karaca, İbrahim; Demir, Ömer; Güler, Oğuz; Özdemir, İsa AykutObjective Colposcopic biopsy is a discomfortable procedure. Additionally, it creates negative influence on sexuality. This study aimed to investigate the relationships among tenaculum, pain perception, and biopsy size during colposcopy. Methods In total, 228 patients who underwent colposcopy-directed biopsy were included, and randomized into 4 groups based on whether analgesic and tenaculum were used and replaced (tenaculum with n=58/without analgesic n=56, no tenaculum replacement with n=57/without analgesic n=57). Lidocaine hydrochloride (40 mg) plus adrenaline (0.025 mg) was administered in the analgesic groups. The pain was assessed using a linear visual analog scale. The biopsy specimen size was measured in millimeters. Results The mean age of the patients was 42.85±8.88 years. The most frequent colposcopy indications were atypical squamous cells of undetermined significance and human papilloma virus-positive results on cervical cytology (30.2%; n=69). Low-and high-grade intraepithelial lesions were noted in 14.91% (n=34) and 10.96% (n=25) women through colposcopy-directed biopsy results, respectively. Tenaculum replacement increased pain perception in the without analgesic group; however, no statistically significant differences were noted between of the groups with and without tenaculum replacement with analgesic. The size and number of biopsy specimens were not associated with tenaculum replacement and analgesic use. Conclusion Administration of analgesics decreased discomfort and pain in patients. Tenaculum replacement aided colposcopists in manipulating the cervix. Additionally, administration of analgesics relieved pain in the tenaculum replacement group.Öğe Comparison of postoperative benign pelvic cysts occurred after gynecologic or gyne-oncologic surgery treated with percutaneous transcatheteric sclerosant alcohol therapy(Wolters Kluwer Medknow Publications, 2020) Comba, Cihan; Erbahçeci Salık, Aysun; Demirayak, Gökhan; Erdoğan, Şakir Volkan; Saçan, Filiz; Özdemir, İsa AykutObjectives: Here, we compare the success of percutaneous transcatheter sclerosant alcohol therapy (PTSAT) for the postoperative treatment of benign pelvic cysts that occurred after gynecologic surgery. Materials and Methods: The study is a retrospective case-control trial. Gynecological patients who had symptoms due to postoperative pelvic cysts and received PTSAT after gynecologic surgery, between October 2008 and January 2018, were examined in a single training and research hospital in Turkey. Some factors were investigated for associations with postoperative pelvic cyst formation in patients who underwent gynecologic operations for malignancies or benign conditions. Statistical analysis used: The association between two independent and nonnormally distributed continuous variables was analyzed with the Mann-Whitney U-test. Spearman's rho correlation analysis was conducted to determine the correlation of two nonnormally distributed variables. Chi-square (or Fisher's exact test, when more suitable) was used to examine the correlation between categorical variables. Results: Statistically significant differences were found in terms of the average age was higher in patients with malignancies, and the average postoperative pelvic cyst detection time was higher in patients with benign pelvic cysts. While all patients were treated with PTSAT, repetitive PTSAT was required for seven benign and ten malign cases. Conclusion: Patients with pelvic cysts that occurred after gynecologic surgery for malignant conditions, large volume pelvic cysts and patients with benign cysts who underwent more than one surgery required recurrent PTSAT.Öğe Management of granulosa cell ovarian tumors: 10-year experience in a tertiary center(Galenos Publishing House, 2022) Karakaş, Sema; Önder, Ayşe Büşra; Demirayak, Gökhan; Comba, Cihan; Avşar, Selim; Akay, Burcu; Süzen Çaypınar, Sema; Özdemir, AykutObjective: Granulosa cell tumors (GCT) arise from the mesenchymal cells and sex cords of the ovaries and can be observed in women of all age groups. This study presented our 10 year-long gynecology oncology experience on the clinical course and outcome of GCT cases. Methods: Thirty-one patients who were operated due to suspicious adnexal masses in our hospital between January 2011 and January 2018 and whose final pathology report confirmed the diagnosis of GCT was included in the study. The data of the patients were evaluated. Preoperative ultrasound findings and serum tumor marker results are noted. Results: Twenty-nine (94%) patients were diagnosed with AGCS and only two (6%) patients were diagnosed with JGCS. The mean age of the study population was 47.74 14.47 years and the mean body mass index was 32.51 7.1. Most patients presented with heavy menstrual bleeding (29%). 48.4% of the patients underwent hysterectomy with bilateral salpingo-oophorectomy, and complete lymph-node dissection, whereas 22.6% of them had hysterectomy with bilateral salpingo-oophorectomy, and 29% of them had oophorectomy only. Three patients (9.3%) had a disease recurrence. The overall survival was 54.4 29.3 months and disease free survival was 49.6 24.2 months. Conclusion: The most important predictor of survival among patients with GCT is a disease stage at the time of initial diagnosis. Long-term surveillance, including routine clinical follow-up and evaluation of tumor markers is mandatory.Öğe Robotic or laparoscopic approach for hysterectomy: Comparison of operative outcomes and cost(Cukurova University, 2021) Karakaş, Sema; Demirayak, Gökhan; Erdoğan, Şakir Volkan; Erdoğan, Aliye; Önder, Ayşe Büşra; Özdemir, İsa Aykut; Comba, Cihan; Süzen Çaypınar, Sema; Ekin, Murat; Yaşar, Levent; Afşar, SelimPurpose: The present study aimed to compare surgical outcomes and cost analysis of robotic-assisted surgery (RAS) and conventional laparoscopic surgery (CLS) hysterectomy procedures. Materials and Methods: The patients who underwent total robotic hysterectomy or total conventional laparoscopic hysterectomy with or without bilateral salpingo-oophorectomy due to benign gynecological disorders such as uterine fibroid, abnormal uterine bleeding, endometrial hyperplasia, adenomyosis, persistent ovarian cysts, chronic pelvic pain were retrospectively evaluated. Results: A total of 80 women underwent RAS or CLS hysterectomy during the study period. The mean total operative time was 187 +/- 10 min. in RAS and 133 +/- 24 min. in CLS groups, respectively. The mean total cost of the RAS hysterectomy group was 17.710 TL, and CLS hysterectomy group was 7000 TL. Conclusion: Both CLS and RAS hysterectomies for benign gynecological indications are safe surgical procedures with negligible complication rates. RAS is a more expensive procedure compared to CLS.Öğe The association between the preoperative prognostic nutritional index and the controlling nutritional status score on tumor stage, chemotherapeutic response and overall survival in ovarian cancer(Routledge Journals, 2022) Karakaş, Sema; Demirayak, Gökhan; Önder, Ayşe Büşra; Özdemir, İsa Aykut; Comba, Cihan; Süzen Çaypınar, Sema; Yıldız, Şükrü; Avşar, Selim; Bağhaki, Sema; Yıldız, Güneş Özlem; Erdoğan, Şakir VolkanObjective: This study aimed to investigate the association between preoperative prognostic nutritional index (PNI) and controlling nutritional status (CONUT) scores on the stage of ovarian cancer (OC), chemotherapeutic response, and overall survival (OS) in patients with OC. Methods: The data of the patients who operated due to OC between January 2015 and January 2020 in a tertiary referral hospital were recorded. The patients' basic characteristics, preoperative total cholesterol, albumin, lymphocyte count, tumor markers, disease stage, grade, chemotherapeutic response, OS, and progression-free survival were recorded. The PNI and the CONUT score were calculated. Results: The mean PNI level was considerably higher in the early-stage group than the advanced-stage group (50.02 +/- 6.8 vs. 46.3 +/- 7.4, p = 0.005). The AUC was 63% for the cutoff point 45.98 of PNI, whereas the AUC was 42% for the cutoff point 1.5 of CONUT score in predicting early-stage disease. The PFS and OS were significantly higher in the high PNI group than the low PNI group (p = 0.01, p = 0.002, respectively). Conclusion: The patients with early-stage OC had significantly higher PNI levels and lower CONUT scores in our study population.Öğe The effect of omentectomy on the blood levels of adipokines in obese patients with endometrial cancer(Elsevier Ltd, 2022) Comba, Cihan; Özdemir, İsa Aykut; Demirayak, Gökhan; Erdoğan, Şakir Volkan; Demir, Ömer; Yıldız, Güneş Özlem; Bulut, Huri; Karakaş, Sema; Gülseren, Varol; Afşar, Selim; Güngördük, KemalObjective: To investigate the blood levels of adipokines in obese patients with endometrial cancer who have and have not undergone omentectomy. Methods: Between September 2017 and September 2019, the study recruited 54 patients with endometrial cancer. Measurements were taken of blood levels of human leptin, perilipin-1, adiponectin, adipolin, resistin, visfatin, and estrone preoperatively and postoperatively before adjuvant therapy or at the end of one month. The serum samples were separated by centrifugation for 10 mins at 3,000 revolutions/min, then stored at ?80 °C until assay. Results: In this prospective study, a total of 54 endometrial cancer patients were analyzed in two separate groups according to the omentectomy status. Comprehensive staging surgery with omentectomy and without omentectomy was performed in 26 patients and 28 patients, respectively. The age, body mass index, body fat index, waist circumference, and skin thickness values of the patients with and without omentectomy were found to be similar. No statistically significant difference was determined between the patients with and without omentectomy in respect of the blood level of the adipokines measured preoperatively. A strong statistically significant correlation was determined between the pre and postoperative levels of Human Leptin (p = 0.002), perilipin-1(p = 0.001), adipolin (p < 0.001), adiponectin (p < 0.001), resistin (p = 0.001), visfatin (p < 0.001), and estrone (p = 0.004) (r = ?0.43, ?0.47, 0.75, 0.84, ?0.47, - 0.58, ?0.41, respectively) Conclusions: Omentectomy affected the postoperative blood levels of adipokines in obese patients with endometrial cancer. As omentectomy may have some positive effects on metabolism in these patients, it may be considered during endometrial cancer surgery due to the possible positive metabolic effects.Öğe Transvaginal natural orifice transluminal endoscopic surgery (VNOTES) retroperitoneal sentinel lymph node BIOPSY compared with conventional laparoscopy in patients with endometrial cancer(2024) Comba, Cihan; Karakaş, Sema; Erdoğan, Şakir Volkan; Demir, Ömer; Şimşek, Erkan; Karaşabanoğlu, Fatma; Demirayak, Gökhan; Özdemir, İsa AykutIntroduction: To explore the possibility of treatment with VNOTES sentinel lymph node dissection concept in patients with endometrial cancer. Methods: Patients who underwent VNOTES sentinel lymph node biopsy with the Comba modification were compared to patients who underwent conventional laparoscopic sentinel lymph node biopsy performed by the same surgical team. A total of 38 patients who underwent sentinel lymph node biopsy + total laparoscopic hysterectomy and bilateral salpingo-oophorectomy (BSO) were compared with 19 patients who underwent VNOTES retroperitoneal sentinel lymph node biopsy + hysterectomy and BSO. Surgical steps were described. Results: The average operation time, perioperative blood loss, the number of sentinel lymph nodes, presence of complications, and preoperative-postoperative hemoglobin-hematocrit differences, tumor stages, grades, largest tumor diameter, depths of invasion, and histological subtypes were similar in both the VNOTES and conventional laparoscopy groups. The postoperative pain scores were lower and the hospital stay was shorter in the VNOTES group than in the conventional laparoscopy group. No disease recurrence had been detected in either group at the time of writing. Conclusion: Compared to conventional laparoscopy, sentinel lymph node biopsy with the VNOTES technique provides similar surgical results and is more advantageous in terms of postoperative pain and hospital length of stay.Öğe Transvaginal natural orifice transluminal endoscopic surgery (VNOTES) total retroperitoneal sentinel lymph node biopsy for an endometrial cancer patient with prior colon cancer surgery(BMJ Publishing Group, 2021) Comba, Cihan; Demirayak, Gökhan; Şimşek, Çiğdem; Şeker Ataş, Büşra; Özdemir, İsa AykutEndometrial cancer (EC) is the most common gynecological malignancy. Although EC is surgically staged, sentinel lymph node biopsy has become more widely used and has been featured in recently published guidelines for EC.Öğe Videoendoscopic sentinel lymph node detection with icg and bilateral inguinofemoral lymphadenectomy in vulvar cancer comba- ozdemir technique(Korean Society of Obstetrics and Gynecology, 2021) Comba, Cihan; Erdoğan, Şakir Volkan; Erdoğan, Aliye; Bağdatlı, Ayşenur; Şeker Ataş, Büşra; Demir, Ömer; Özdemir, İsa AykutThe authors present a surgical film for vulvar cancer surgery, which was performed via video endoscopy. An 88-year-old woman with squamous cell carcinoma of the vulva and who underwent radical vulvectomy was treated with sentinel lymph node (SLN) and bilateral inguinofemoral lymphadenectomy, which is preferably performed via video endoscopic surgery with a near-infrared fluorescence video endoscopy system. SLN mapping was performed using indocyanine green (ICG) and near-infrared fluorescence mapping. SLNs were detected in the left superficial inguinal area. The surgeons performed bilateral inguinofemoral lymphadenectomy. No postoperative early or late complications developed, and the patient was discharged 7 days after surgery. Stage 1B vulvar cancer was identified.
