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Öğe Analysis of the learning curve for robotic hysterectomy for benign gynaecological disease(Wiley, 2014) Sendag, Fatih; Zeybek, Burak; Akdemir, Ali; Ozgurel, Banu; Oztekin, KemalBackgroundThe objective was to evaluate the learning curve for performing a robotic hysterectomy to treat benign gynaecological disease. MethodsThirty-six patients underwent robotic hysterectomy for benign indications. A systematic chart review of consecutive cases was conducted. The collected data included age, BMI, operating time, set-up time, docking time, uterine weight, blood loss, intraoperative complications, postoperative complications, conversions to laparotomy and length of hospital stay. ResultsThe mean operating, set-up and docking times were 16954.5, 52.9 +/- 12.4 and 7.8 +/- 7.6min, respectively. The learning curve analysis revealed a decrease in both docking and operating times, with both curves plateauing after case 9. ConclusionsThe learning curve analysis revealed a decrease in docking time and operating time after case 9, suggesting that there might be a fast, learning curve for experienced laparoscopic surgeons to master robotic hysterectomy, and that the docking process does not have a significant negative influence on the overall operating time. Copyright (c) 2013 John Wiley & Sons, Ltd.Öğe Comparison of three-dimensional ultrasound and magnetic resonance imaging diagnosis in surgically proven Mullerian duct anomaly cases(Elsevier Science Bv, 2016) Ergenoglu, Ahmet Mete; Sahin, Cagdas; Simsek, Deniz; Akdemir, Ali; Yeniel, Ahmet Ozgur; Yerli, Hasan; Sendag, FatihObjective: To determine and compare the diagnostic accuracy of 3-dimensional ultrasound (3D US) and magnetic resonance imagining (MRI) in patients with surgically diagnosed Mullerian duct anomaly (MDA). Study design: Charts of patients with MDA were retrospectively evaluated. Patients who underwent both laparoscopic and hysteroscopic surgery and had 3D US and MRI examinations were included in the study. The diagnoses achieved via 3D US and MRI were compared with the surgical diagnoses to determine the diagnostic accuracy of these imagining techniques. Results: Twenty-nine patients were included in the study. Three-dimensional ultrasound detected 28 out of 29 (96%) patients correctly. Only one patient was diagnosed with a uterine septum instead of uterine arcuatus. Magnetic resonance imaging detected 23 out of 29 patients correctly (79%). The Kappa indexes of the 3D US and MRI were 0.896 and 0.592, respectively. Conclusion: Our results indicate that 3D US has a higher diagnostic accuracy level than MRI in evaluating MDA, especially when used in experienced hands. However, additional, well-designed studies are needed to better compare the diagnostic accuracy of the 3D US and MRI. Crown Copyright (C) 2015 Published by Elsevier Ireland Ltd. All rights reserved.Öğe Coring-type laparoscopic resection of a cavitated non-communicating rudimentary horn under hysteroscopic assistance(Wiley-Blackwell, 2014) Akdemir, Ali; Ergenoglu, Ahmet Mete; Yeniel, Ahmet Ozgur; Sendag, Fatih; Karadadas, NedimNon-communicating accessory uterine horns with an endometrial cavity are the most common and clinically significant unicornuate subtype of M llerian duct abnormality. They are generally associated with symptoms of dysmenorrhea, dyspareunia, infertility, endometriosis, adhesions, and life-threatening cornual pregnancy. Treatment options include surgical resection of the rudimentary horn, hysteroscopic recanalization, and endometrial ablation. Currently, laparoscopic resection is the recommended treatment choice. Dissection of the rudimentary horn from the unicornuate uterus is the most challenging part of this procedure and may compromise the remaining unicornuate uterus wall. Here we describe a case of laparoscopic coring-type resection of a non-communicating functional rudimentary horn firmly attached to the unicornuate uterus, by using hysteroscopic assistance. The use of hysteroscopy, adjunct to laparoscopy, facilitates the coring-type resection and may strengthen the remaining myometrial scar.Öğe Effect of ovarian stimulation with human menopausal gonadotropin and recombinant follicle stimulating hormone on the expression of integrins alpha(3), beta(1) in the rat endometrium during the implantation period(Elsevier Science Bv, 2010) Sendag, Fatih; Akdogan, Aysin; Ozbilgin, Kemal; Giray, Guelsen; Oztekin, KemalObjective: To investigate the effect of exogenous ovarian stimulation with human menopausal gonadotropin (hMG) and recombinant follicle stimulating hormone (rFSH) on the expression of integrins alpha(3), beta(1) in the rat endometrium during implantation. Study design: Following three successive normal estrous cycles the animals were divided into five groups: Group I (n = 10, control group) received no medication; Group II (n = 10) received 10 units of hMG; Group III (n = 10) received 20 units of hMG; Group IV (n = 10) received 10 units of rFSH; Group V (n = 10) received 20 units of rFSH at midday of middiestrous. The rats were then mated with fertile males. The animals were sacrificed on the day of implantation. The uterine horns were placed in fixative and paraffin blocks of the tissue were cut in 5 mu m sections. The tissues were stained with primary antibodies; monoclonal anti-integrin alpha(3) and monoclonal anti-integrin beta(1) using immunohistochemical methods. The staining intensities of alpha(3) and beta(1) integrins were calculated separately for epithelium and stroma in each group. Results: Staining intensities of alpha(3) and beta(1) integrins in both the epithelium and the stroma were significantly lower in the treatment groups than the control group (p < 0.05). Conclusion: Ovarian stimulation by low and high doses of HMG and rFSH may have an effect on endometrial receptivity, possibly via a decrease in expression of integrins in the endometrium during the implantation period. (C) 2010 Elsevier Ireland Ltd. All rights reserved.Öğe THE EFFECT OF POSTMENOPAUSAL HORMONE REPLACEMENT THERAPY ON THE NUMBER AND THE ACTIVATION OF T-CELLSUBPOPULATIONS AND ON THE NUMBER OF B CELLS AND NATURAL KILLER CELLS(2005) Sendag, Fatih; Terzioglu, Tulay; Terzioglu, Ender; Terek, Mustafa Coşan; Oztekın, K; Özşener, Serdar; Bılgın, O…Öğe Effect of spaced training with a box trainer on the acquisition and retention of basic laparoscopic skills(Elsevier Ireland Ltd, 2014) Akdemir, Ali; Zeybek, Burak q; Ergenoglu, Ahmet M.; Yeniel, Ahmet O.; Sendag, FatihObjective: To investigate whether basic laparoscopic skills acquired via structured spaced training on a box trainer persist after 6 months. Methods: In a prospective study undertaken at the Ege University School of Medicine (Izmir, Turkey) between January 1, 2012, and June I, 2013, 22 gynecology residents without previous laparoscopy experience were randomly assigned (1:1) to receive training with a box trainer (1 hour per week for 4 weeks) or to a control group. At baseline and at 5 weeks, residents' performance was assessed via the salpingectomy module of LapSim. The box trainer group was reassessed for skills retention 6 months later. Results: The box trainer group performed significantly better than the control group in time (P = 0.01) and economy of movement (P = 0.001) at the final test. Error scores did not differ significantly. Deterioration between final and retention tests in the box trainer group were recorded in time (P = 0.041), instrument path length (P = 0.013), and instrument angular path (P = 0.075). However, time and economy of movement scores were better at the retention assessment than at baseline (P = 0.008 and P = 0.003, respectively). Conclusion: Structured training with a box trainer improved laparoscopic skills, but deterioration was evident within 6 months. This deterioration should be considered when planning laparoscopic training programs. (C) 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.Öğe Effectiveness of a one-day laparoscopic suture course(Taylor & Francis Inc, 2019) Peker, Nuri; Biler, Alper; Hortu, Ismet; Sendag, FatihWe aimed to determine the effectiveness of a one-day course on laparoscopic suturing skills development by performing a prospective study with obstetrics and gynaecology specialists. The course consisted of a theoretical portion describing the suturing technique basics and a practical portion consisting of box trainer suturing. Before and after the course, each trainee was given 10 min to introduce the suture material into the abdomen, properly position the needle using a needle holder, pass the suture through premarked points on the silicone pads and tie an intracorporeal knot. The procedures were video recorded and evaluated after the course. The results showed that there were statistically significant reductions in the needle holding, suture passing and knot tying times after completing the course. Overall, the one-day course was an effective training programme for improving a surgeon's laparoscopic suturing skills.IMPACT STATEMENT What is already known on this subject? Currently, many countries have centres that provide laparoscopic training as part of the medical residency education. However, a standardised training programme has not been implemented worldwide. What do the results of this study add? In this study, we pointed out the effectiveness of a one-day laparoscopic suturing course. A one-day suturing course is easy to implement, cheap and effective.Öğe Effectiveness of the world's first 1-Day online hands-on laparoscopic suturing training during COVID-19 pandemic(Taylor & Francis Inc, 2022) Akdemir, Ali; Cakmak, Kubra; Ari, Sabahattin Anil; Sendag, FatihWe aimed to investigate the effectiveness of an online laparoscopic suturing training course conducted via an online meeting program. The mean needle loading, stitching, and knot-tying times were 77.3 s, 63.0 s, and 140.3 s, respectively on the initial test. Total laparoscopic suture time before the course was 273.8 s. After the course, time measures across all parameters decreased significantly (p < .001). The mean needle loading, suture passing, and knot tying times were 25.0 s, 31.0 s, and 34.6 s on the final test. The total intracorporeal suture time after the course was 90.0 s. The Objective and Structured Assessment of Technical Skills Scores significantly increased from 16.8 at the initial test to 25.4 at the final test (p < .001).IMPACT STATEMENT What is already known on this subject? Training models like box trainers and virtual reality simulators have frequently been shown to significantly improve laparoscopic skills. What the results of this study add? A 1-day online laparoscopic suturing course significantly reduces the intracorporeal suturing time. What the implications are of these findings for clinical practice and/or further research? Basis the results, online laparoscopic suturing training might become the new norm for training over conventional training given the benefits of cost and time savings.Öğe The Effects of Different Intraabdominal Pressure Protocols in Laparoscopic Procedures on Oxidative Stress Markers and Morphology in Rat Ovaries(Wroclaw Medical Univ, 2014) Biler, Alper; Yucebilgin, Sait; Sendag, Fatih; Akman, Levent; Akdemir, Alt; Ates, Utku; Uyanikgil, Yigit; Yilmaz-Dilsiz, Ozlem; Sezer, EbruBackground. To determine the effects of different intraabdominal pressure (TAP) on the ovaries in a laparoscopic rat model. Objectives. The aim of the study was to determine the effects on the ovaries of different intraabdominal pressures (TAP) in laparoscopic surgery in a rat model. Material and Methods. Thirty-two post-pubertal nonpregnant Sprague-Dawley rats were divided randomly into four groups. In the control group, no intraabdominal pressure (TAP) was applied. In Group Pp10 and Group Pp15, an TAP of 10 and 15 mm Hg, respectively, were applied by carbon dioxide insufflation for 60 min, and a 30-min desufflation was carried out. In Group IPp15, a 15 mm Hg TAP was applied for 10 min, and then CO2 was desufflated for 10 min. After this ischemic preconditioning, IAP was established at 15 mm Hg for 60 min, after which CO2 was desufflated for 30 min. Erythrocyte and ovarian tissue maiondialdehyde (MDA) and histopathologic damage scores were evaluated. Results. In Groups Pp10 and Pp 15, ovarian tissue MDA values were significantly increased compared to the control group. In Groups Pp10 and Pp15, erythrocyte MDA values were significantly increased when compared to Group IPp15 and the control group. Ovarian histopatological assesment scores were significantly higher in Group Pp15 than in Groups Ppl 0 and IPp15. Conclusions. Pneumoperitoneum causes injuries to abdominal organ such as the ovaries. The ischemic preconditioning method is more effective in reducing oxidative stress due to laparoscopic pneumoperitoneum than lowpressure pneumoperitoneum methodsÖğe The effects of two different teaching techniques on the knowledge level of nursing students about HPV(Aves Press Ltd, 2015) Dag, Hande; Donmez, Sevgul; Sezer, Hale; Sendag, Fatih; Sevil, Umran; Saruhan, AynurThis study's purpose is to increase nursing students' knowledge level about HPV and vaccines of HPV, and encourage them to be vaccinated by using two different discussion based teaching techniques. This study performed with 40 volunteer students selected by simple random method by using Scenario Based Learning (SBLT) and Phillips 66 Teaching Techniques (PTT) and pre-post-test quasi-experimental model between 01.09.2013 to 31.01.2014. In data collection, Individual Data Collection Form (IDCF) and Knowledge Level Measurement Questionnaire (KLMQ) were used. Knowledge Retention Test (KRT) was administered to students after 20 days. In data analysing, Chi-square and Fisher's Exact Tests were used. HPV and vaccination knowledge of the students were found 57.5% insufficient and 65% of them not believe the protectiveness of HPV vaccine. There were statistically significant diffence between the students' believe of the protectiveness of HPV vaccine and the desire of them to be vaccinated (p=0.00). There were not any diffence between the techniques' effects on achievement level (AL) of the students after education (p>0.05). But, there were significant diffence between AL of the students before and after the education (p=0.00). There were not any diffence between after the education and KRT AL of the students (p>0.05). 20 days after the education, 87.5% of them believe the protectiveness of HPV vaccine. 85% of them wanted to be vaccinated after the education. These teaching techniques increased students knowledge of HPV, but between them there were not any significant difference. The vaccine protectiveness believes of them and expensiveness of the vaccine effect their vaccination request.Öğe The effects of two different teaching techniques on the knowledge level of nursing students about HPV(Aves Press Ltd, 2015) Dag, Hande; Donmez, Sevgul; Sezer, Hale; Sendag, Fatih; Sevil, Umran; Saruhan, AynurThis study's purpose is to increase nursing students' knowledge level about HPV and vaccines of HPV, and encourage them to be vaccinated by using two different discussion based teaching techniques. This study performed with 40 volunteer students selected by simple random method by using Scenario Based Learning (SBLT) and Phillips 66 Teaching Techniques (PTT) and pre-post-test quasi-experimental model between 01.09.2013 to 31.01.2014. In data collection, Individual Data Collection Form (IDCF) and Knowledge Level Measurement Questionnaire (KLMQ) were used. Knowledge Retention Test (KRT) was administered to students after 20 days. In data analysing, Chi-square and Fisher's Exact Tests were used. HPV and vaccination knowledge of the students were found 57.5% insufficient and 65% of them not believe the protectiveness of HPV vaccine. There were statistically significant diffence between the students' believe of the protectiveness of HPV vaccine and the desire of them to be vaccinated (p=0.00). There were not any diffence between the techniques' effects on achievement level (AL) of the students after education (p>0.05). But, there were significant diffence between AL of the students before and after the education (p=0.00). There were not any diffence between after the education and KRT AL of the students (p>0.05). 20 days after the education, 87.5% of them believe the protectiveness of HPV vaccine. 85% of them wanted to be vaccinated after the education. These teaching techniques increased students knowledge of HPV, but between them there were not any significant difference. The vaccine protectiveness believes of them and expensiveness of the vaccine effect their vaccination request.Öğe The effects of two different teaching techniques on the knowledge level of nursing students about HPV(Aves Press Ltd, 2015) Dag, Hande; Donmez, Sevgul; Sezer, Hale; Sendag, Fatih; Sevil, Umran; Saruhan, AynurThis study's purpose is to increase nursing students' knowledge level about HPV and vaccines of HPV, and encourage them to be vaccinated by using two different discussion based teaching techniques. This study performed with 40 volunteer students selected by simple random method by using Scenario Based Learning (SBLT) and Phillips 66 Teaching Techniques (PTT) and pre-post-test quasi-experimental model between 01.09.2013 to 31.01.2014. In data collection, Individual Data Collection Form (IDCF) and Knowledge Level Measurement Questionnaire (KLMQ) were used. Knowledge Retention Test (KRT) was administered to students after 20 days. In data analysing, Chi-square and Fisher's Exact Tests were used. HPV and vaccination knowledge of the students were found 57.5% insufficient and 65% of them not believe the protectiveness of HPV vaccine. There were statistically significant diffence between the students' believe of the protectiveness of HPV vaccine and the desire of them to be vaccinated (p=0.00). There were not any diffence between the techniques' effects on achievement level (AL) of the students after education (p>0.05). But, there were significant diffence between AL of the students before and after the education (p=0.00). There were not any diffence between after the education and KRT AL of the students (p>0.05). 20 days after the education, 87.5% of them believe the protectiveness of HPV vaccine. 85% of them wanted to be vaccinated after the education. These teaching techniques increased students knowledge of HPV, but between them there were not any significant difference. The vaccine protectiveness believes of them and expensiveness of the vaccine effect their vaccination request.Öğe Infertility and the Presence of Insulin Resistance Are Associated With Increased Oxidative Stress in Young, Non-obese Turkish Women With Polycystic Ovary Syndrome(Elsevier Science Inc, 2015) Turan, Volkan; Sezer, Ebru Demirel; Zeybek, Burak; Sendag, FatihStudy Objective: To investigate the relationship between both insulin resistance and fertility and the oxidant/antioxidant system in young, non-obese patients diagnosed with polycystic ovary syndrome (PCOS). Design: Case-control study. Setting: Department of Obstetrics and Gynecology, Ege University, Izmir, Turkey. Participants: PCOS patients without insulin resistance (IR-) (n = 33), PCOS patients with insulin resistance (IR+) (n = 27), and healthy controls (n = 30). Patients with PCOS and regular sexual intercourse were further divided into infertile (n = 14) and fertile (n = 15) groups. Main Outcome Measures: The malondialdehyde (MDA) and thiol levels as well as the catalase (CAT) and superoxide dismutase (SOD) enzyme activities. Results: Both IR+ and IR- PCOS patients had higher MDA levels and lower thiol levels when compared to the controls (each P < .001). However, only IR- patients had significantly higher SOD (3700.81 +/- 410.13 vs 2614.19 +/- 611.80 U/g Hb; P < .001) and CAT (7565.06 +/- 628.27 vs 6819.61 +/- 539.2 U/g Hb; P < .001) activities when compared to the controls. Infertile PCOS patients had significantly higher MDA levels (347.5 +/- 22.8 vs 278.6 +/- 42.6 nmol/g Hb, P < .001) and lower thiol levels (498.5 +/- 56.2 vs 568.5 +/- 38.6 mu mol/l, P = .001) when compared to fertile patients. Conclusions: The results of this study demonstrated an imbalance in the oxidative-antioxidative system of PCOS patients. This imbalance was worse in IR+ and infertile PCOS patients.Öğe Infertility and the Presence of Insulin Resistance Are Associated With Increased Oxidative Stress in Young, Non-obese Turkish Women With Polycystic Ovary Syndrome(Elsevier Science Inc, 2015) Turan, Volkan; Sezer, Ebru Demirel; Zeybek, Burak; Sendag, FatihStudy Objective: To investigate the relationship between both insulin resistance and fertility and the oxidant/antioxidant system in young, non-obese patients diagnosed with polycystic ovary syndrome (PCOS). Design: Case-control study. Setting: Department of Obstetrics and Gynecology, Ege University, Izmir, Turkey. Participants: PCOS patients without insulin resistance (IR-) (n = 33), PCOS patients with insulin resistance (IR+) (n = 27), and healthy controls (n = 30). Patients with PCOS and regular sexual intercourse were further divided into infertile (n = 14) and fertile (n = 15) groups. Main Outcome Measures: The malondialdehyde (MDA) and thiol levels as well as the catalase (CAT) and superoxide dismutase (SOD) enzyme activities. Results: Both IR+ and IR- PCOS patients had higher MDA levels and lower thiol levels when compared to the controls (each P < .001). However, only IR- patients had significantly higher SOD (3700.81 +/- 410.13 vs 2614.19 +/- 611.80 U/g Hb; P < .001) and CAT (7565.06 +/- 628.27 vs 6819.61 +/- 539.2 U/g Hb; P < .001) activities when compared to the controls. Infertile PCOS patients had significantly higher MDA levels (347.5 +/- 22.8 vs 278.6 +/- 42.6 nmol/g Hb, P < .001) and lower thiol levels (498.5 +/- 56.2 vs 568.5 +/- 38.6 mu mol/l, P = .001) when compared to fertile patients. Conclusions: The results of this study demonstrated an imbalance in the oxidative-antioxidative system of PCOS patients. This imbalance was worse in IR+ and infertile PCOS patients.Öğe Infertility and the Presence of Insulin Resistance Are Associated With Increased Oxidative Stress in Young, Non-obese Turkish Women With Polycystic Ovary Syndrome(Elsevier Science Inc, 2015) Turan, Volkan; Sezer, Ebru Demirel; Zeybek, Burak; Sendag, FatihStudy Objective: To investigate the relationship between both insulin resistance and fertility and the oxidant/antioxidant system in young, non-obese patients diagnosed with polycystic ovary syndrome (PCOS). Design: Case-control study. Setting: Department of Obstetrics and Gynecology, Ege University, Izmir, Turkey. Participants: PCOS patients without insulin resistance (IR-) (n = 33), PCOS patients with insulin resistance (IR+) (n = 27), and healthy controls (n = 30). Patients with PCOS and regular sexual intercourse were further divided into infertile (n = 14) and fertile (n = 15) groups. Main Outcome Measures: The malondialdehyde (MDA) and thiol levels as well as the catalase (CAT) and superoxide dismutase (SOD) enzyme activities. Results: Both IR+ and IR- PCOS patients had higher MDA levels and lower thiol levels when compared to the controls (each P < .001). However, only IR- patients had significantly higher SOD (3700.81 +/- 410.13 vs 2614.19 +/- 611.80 U/g Hb; P < .001) and CAT (7565.06 +/- 628.27 vs 6819.61 +/- 539.2 U/g Hb; P < .001) activities when compared to the controls. Infertile PCOS patients had significantly higher MDA levels (347.5 +/- 22.8 vs 278.6 +/- 42.6 nmol/g Hb, P < .001) and lower thiol levels (498.5 +/- 56.2 vs 568.5 +/- 38.6 mu mol/l, P = .001) when compared to fertile patients. Conclusions: The results of this study demonstrated an imbalance in the oxidative-antioxidative system of PCOS patients. This imbalance was worse in IR+ and infertile PCOS patients.Öğe Innovative Technique for Enclosed Morcellation Using a Surgical Glove(Lippincott Williams & Wilkins, 2015) Akdemir, Ali; Taylan, Enes; Zeybek, Burak; Ergenoglu, Ahmet Mete; Sendag, FatihOBJECTIVE: To describe an innovative approach for enclosed morcellation using a surgical glove in multiport laparoscopic surgery. METHODS: Power morcellation was performed within an insufflated surgical glove in a completely enclosed manner between January and May 2014. The specimen was placed into the glove within the abdomen. The glove opening and thumb were exteriorized through the umbilical and left lower abdominal trocar incisions, respectively. The optical trocar and optic were inserted into the glove, which was then insufflated. The thumb tip was cut, and a power morcellator was inserted through this finger. The morcellation was accomplished within the completely enclosed glove. The thumb tip was closed, and the glove, containing residual specimens and bloody fluid, was removed from the abdomen through the umbilical incision. Thus, the risks of bag piercing and leakage during contained power morcellation were eliminated. Demographic and operative data were collected and analyzed for all cases. RESULTS: Thirty multiport laparoscopic myomectomy and morcellation procedures were performed during the study period. The median operative time was 85 minutes (range 60-140 minutes). The median morcellation preparation time, total morcellation time, and withdrawal time were 6 (range 4.5-14), 32 (range 15-55), and 1.2 (range 1-1.5) minutes, respectively. No intraoperative complications or bag ruptures were recorded. CONCLUSION: With our innovative technique, a disposable latex glove can be used for an enclosed morcellation that avoids piercing the enclosure container within the abdominal cavity, thereby offering decreased risks related to bag perforation and leakage compared with previous contained power morcellation techniques.Öğe Innovative Technique for Enclosed Morcellation Using a Surgical Glove(Lippincott Williams & Wilkins, 2015) Akdemir, Ali; Taylan, Enes; Zeybek, Burak; Ergenoglu, Ahmet Mete; Sendag, FatihOBJECTIVE: To describe an innovative approach for enclosed morcellation using a surgical glove in multiport laparoscopic surgery. METHODS: Power morcellation was performed within an insufflated surgical glove in a completely enclosed manner between January and May 2014. The specimen was placed into the glove within the abdomen. The glove opening and thumb were exteriorized through the umbilical and left lower abdominal trocar incisions, respectively. The optical trocar and optic were inserted into the glove, which was then insufflated. The thumb tip was cut, and a power morcellator was inserted through this finger. The morcellation was accomplished within the completely enclosed glove. The thumb tip was closed, and the glove, containing residual specimens and bloody fluid, was removed from the abdomen through the umbilical incision. Thus, the risks of bag piercing and leakage during contained power morcellation were eliminated. Demographic and operative data were collected and analyzed for all cases. RESULTS: Thirty multiport laparoscopic myomectomy and morcellation procedures were performed during the study period. The median operative time was 85 minutes (range 60-140 minutes). The median morcellation preparation time, total morcellation time, and withdrawal time were 6 (range 4.5-14), 32 (range 15-55), and 1.2 (range 1-1.5) minutes, respectively. No intraoperative complications or bag ruptures were recorded. CONCLUSION: With our innovative technique, a disposable latex glove can be used for an enclosed morcellation that avoids piercing the enclosure container within the abdominal cavity, thereby offering decreased risks related to bag perforation and leakage compared with previous contained power morcellation techniques.Öğe Innovative Technique for Enclosed Morcellation Using a Surgical Glove(Lippincott Williams & Wilkins, 2015) Akdemir, Ali; Taylan, Enes; Zeybek, Burak; Ergenoglu, Ahmet Mete; Sendag, FatihOBJECTIVE: To describe an innovative approach for enclosed morcellation using a surgical glove in multiport laparoscopic surgery. METHODS: Power morcellation was performed within an insufflated surgical glove in a completely enclosed manner between January and May 2014. The specimen was placed into the glove within the abdomen. The glove opening and thumb were exteriorized through the umbilical and left lower abdominal trocar incisions, respectively. The optical trocar and optic were inserted into the glove, which was then insufflated. The thumb tip was cut, and a power morcellator was inserted through this finger. The morcellation was accomplished within the completely enclosed glove. The thumb tip was closed, and the glove, containing residual specimens and bloody fluid, was removed from the abdomen through the umbilical incision. Thus, the risks of bag piercing and leakage during contained power morcellation were eliminated. Demographic and operative data were collected and analyzed for all cases. RESULTS: Thirty multiport laparoscopic myomectomy and morcellation procedures were performed during the study period. The median operative time was 85 minutes (range 60-140 minutes). The median morcellation preparation time, total morcellation time, and withdrawal time were 6 (range 4.5-14), 32 (range 15-55), and 1.2 (range 1-1.5) minutes, respectively. No intraoperative complications or bag ruptures were recorded. CONCLUSION: With our innovative technique, a disposable latex glove can be used for an enclosed morcellation that avoids piercing the enclosure container within the abdominal cavity, thereby offering decreased risks related to bag perforation and leakage compared with previous contained power morcellation techniques.Öğe Is the presence of deep infiltrative endometriosis underestimated in the surgical management of endometriosis?(Via Medica, 2023) Ari, Sabahattin Anil; Akdemir, Ali; Serin, Gurdeniz; Ulukus, Murat; Sendag, FatihObjectives:The aim of the study was to determine the presence of deep infiltrative endometriosis (DIE) in the surgical management of endometriosis.Material and methods: Operation notes and histopathological reports of women with endometriosis were retrospectively analyzed in the Ege University Hospital between 2008 and 2018. A total of 191 women with suspicious of endometriosis but without clinical signs of DIE were enrolled in the study. Laparoscopic diagnosis of DIE was compared with histopatho-logical reports. There was no histopathology before surgery. Endometriosis was suspected only based on symptoms.Results: A total of 213 lesions that were thought to be DIE were removed from 191 women with endometriosis. Among these 213 lesions, 179 specimens were reported as endometriosis and 34 lesions as fibro-adipose tissue. Forty-nine right uterosacral ligaments were excised, and endometriosis was detected in 44 out of 49 specimens. Histopathological examination of 45 left uterosacral ligaments revealed endometriosis in 35 specimens. Finally, 25 endometriotic nodules were removed from the recto-vaginal space, and 22 of these were verified as endometriosis by a pathologist. The positive predictive value of laparoscopic visualization for DIE in the group suspected of endometriosis but without any clinical findings of DIE was 84%.Conclusions: Women with the suspicious of endometriosis, qualified to surgery, because of infertility or pain, should be prudently investigated to confirm or to exclude coexistence of DIE even if no preoperative sign of DIE was observed to provide complete resection. Otherwise, DIE continues to grow, causes pain postoperatively, and complicates subse-quent surgery.Öğe Laparoscopic virtual reality simulator and box trainer in gynecology(Wiley, 2014) Akdemir, Ali; Sendag, Fatih; Oztekin, Mehmet K.Objective: To investigate whether a virtual reality simulator (LapSim) and traditional box trainer are effective tools for the acquisition of basic laparoscopic skills, and whether the LapSim is superior to the box trainer in surgical education. Methods: In a study at Ege University School of Medicine, Izmir, Turkey, between September 2008 and March 2013, 40 first- and second-year residents were randomized to train via the LapSim or box trainer for 4 weeks, and 20 senior residents were allocated to a control group. All 3 groups performed laparoscopic bilateral tubal ligation. Video records of each operation were assessed via the general rating scale of the Objective Structured Assessment of Laparoscopic Salpingectomy and by operation time in seconds. Results: Compared with the control group, the LapSim and box trainer groups performed significantly better in total score (P<0.01 and P<0.01, respectively) and time (P=0.03 and P=0.01, respectively). There were no differences between the LapSim and box trainer groups. Conclusion: Novice residents who trained on a LapSim or box trainer performed better live laparoscopies than residents who trained via standard clinical surgical education. Training with a virtual reality simulator or box trainer should be considered before actual laparoscopic procedures are carried out. (C) 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.