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Öğe Adhesion formation after microlaparoscopic and laparoscopic ovarian coagulation for polycystic ovary disease(Journal Amer Assoc Gynecologic Laparoscopists, 1999) Taskin, O; Sadik, S; Onoglu, A; Gokdeniz, R; Yilmaz, I; Burak, F; Wheeler, JMStudy Objective. To compare the effects of microlaparoscopy and decreased CO2 exposure on peritoneal microcirculation and potential adhesion formation after ovarian surgery with those of conventional operative laparoscopy. Design. Prospective, randomized study (Canadian Task Force classification I). Setting. Teaching hospital. Patients. Eighteen women with polycystic ovary disease. Interventions. Microlaparoscopic or laparoscopic ovarian coagulation of the ovaries. Measurements and Main Results. Approximately 10 to 12 coagulation points were applied to each ovary. Two to 3 weeks after the initial surgery second-look microlaparoscopy was performed to determine the extent of adhesions in both groups. The frequency of adhesion formation and changes in glutathione peroxidase (GSH-Px), superoxide dismutase (SOD), catalase (CAT), and glutathione (GSH) levels were studied in homogenized peritoneal tissues obtained during surgery in each group. Results. Clinical profiles were similar between groups. Mean exposure, amount, and pressure of CO2 were significantly less in the microlaparoscopy group (p <0.05). The laparoscopy group had significantly more adhesions than the microlaproscopy group (24% vs 48%, p <0.05). The GSH-Px, SOD, CAT, and GSH levels were significantly lower in the laparoscopy group (0.425 mu mol, 1.2 ng, 37.55 mu mol, and 0.9 nmol vs 0.755 mu mol, 2.1 ng, 625 mu mol, and 2.6 nmol, respectively). Conclusion. Reduced exposure to and amount of CO2 during microlaparoscopy may result in decreased adhesion formation compared with conventional laparoscopy. This effect may possibly be due to lack of or minimal adverse effects on peritoneal microcirculation and cell-protective systems, which are proposed mechanisms for adhesion formation and closely related to peritoneal injury. In addition, microlaparoscopy may be a cost-effective alternative to conventional laparoscopy.Öğe Laparoscopic management of selected adnexal masses(Journal Amer Assoc Gynecologic Laparoscopists, 1999) Sadik, S; Onoglu, AS; Gokdeniz, R; Turan, E; Taskin, O; Wheeler, JMObjective. To investigate the significance, safety and intraoperative and immediate postoperative outcomes of laparoscopic management of adnexal masses thought to be at low risk for malignancy. Design. Prospective cohort study (Canadian Task Force classification II-2). Setting. Tertiary-care teaching hospital. Patients. Two hundred twenty women undergoing laparoscopic surgery for adnexal masses. Interventions. Laparoscopic treatment including cystectomy oophorectomy, adnexectomy, and peritoneal cytology, and, if necessary, frozen sections. A histologic diagnosis was obtained in every patient. Measurements and Main Results. Only one ovarian cancer and one borderline ovarian tumor were diagnosed by histologic examination, and both were managed by laparotomy. The remaining 218 patients had laparoscopy for benign adnexal masses. Conclusion. Operative laparoscopy with the finding of incidental ovarian malignancy is rare, as shown by pathologic examination. With appropriate preoperative evaluation, laparoscopic surgery is technically feasible, safe, and advantageous, with minimal morbidity, and should replace laparotomy in the management of most adnexal masses.Öğe Long-term histopathologic and morphologic changes after thermal endometrial ablation(Journal Amer Assoc Gynecologic Laparoscopists, 2002) Taskin, O; Onoglu, A; Inal, M; Turan, E; Sadik, S; Vardar, E; Postaci, HStudy Objective. To outline long-term histologic features of endometrial ablation. Design. Prospective longitudinal study (Canadian Task Force classification II-3). Setting. Tertiary-care teaching hospital. Patients. Twenty-six patients. Intervention. Thermal ablation followed by second-look office hysteroscopy with endometrial biopsy. Measurements and Main Results. Mean follow-up time to second-look hysteroscopy after ablation was 33.4 +/- 2, 1 months. Complete atrophy, partial adhesions or obliteration of the cavity, and fibrosis were observed at second-look hysteroscopy. Whereas all random biopsies were normal before ablation, biopsies after ablation revealed diminished endometrial glands with necrosis and scarring. The number of endometrial glands was not correlated with amount of bleeding or menstrual pattern. No premalignant or malignant lesions were found after ablation, Conclusion, Although efficacy of endometrial ablation is related to initial thermal destruction and correlated with postablation hysteroscopic and histologic findings, endometrial regrowth is an expected development, not a failure of ablation.Öğe Role of endometrial suppression on the frequency of intrauterine adhesions after resectoscopic surgery(Journal Amer Assoc Gynecologic Laparoscopists, 2000) Taskin, O; Sadik, S; Onoglu, A; Gokdeniz, R; Erturan, E; Burak, F; Wheeler, JMStudy Objectives. To evaluate long-term effects of operative hysteroscopy on the development of intrauterine adhesions (IUA), and to determine whether hypoestrogenism has a modulatory role in preventing IUA. Design. Prospective, randomized study (Canadian Task Force classification I). Setting. Tertiary-care teaching hospital. Patients. Ninety-five women requiring resectoscopic surgery. Intervention. Hysteroscopic surgery using the resectoscope and 1.5% glycine for uterine distention. Measurements and Main Results. indications for hysteroscopy were polyps (28 patients), solitary myoma (32), multiple myomata (20), and uterine septa (15). Patients in each group were randomized to endometrial suppression with danazol or placebo. Second-look office hysteroscopy with CO2 for uterine distention was performed after the First menses after surgery to assess the frequency, extent, and severity of IUA. The likelihood and severity of IUA depended on the pathology treated at initial surgery. Of women treated For polyps and uterine septa, in only one with septa (placebo group) developed IUA. Mild IUA Formation was present in 10 patients (31.3%) with solitary fibroids and 9 (45.5%) with multiple myomata. The frequency was similar in placebo- and danazol-treated groups with both solitary and multiple myomas (50% and 44.4% vs 50% and 55.6%). All IUA were lysed during second-look surgery except in one woman with multiple myomata who required repeat resectoscopy. Conclusion. Intrauterine adhesions are the major long-tern, complication of operative hysteroscopy, with frequency dependent on the pad,ology initially treated. Second-look office hysteroscopy is a cost-effective method of diagnosing and lysing IUA after resectoscopy.
