V-NOTES hysterectomy under spinal anaesthesia: A pilot study

Background: Spinal anaesthesia has not been widely adopted for laparoscopic surgeries until now. There are a few studies that have shown that spinal anaesthesia is at least as safe as general anaesthesia. The need for additional analgesics can be reduced by utilising early postoperative analgesic effects of spinal anaesthesia, and maximum benefit can be obtained from minimally invasive approaches when V-NOTES surgery is performed under spinal anaesthesia. Objective: Combining V-NOTES with spinal anaesthesia to improve minimally invasive surgical techniques and provide maximum benefit to patients. Materials and methods: Patients who were found to have benign pelvic organ pathologies, required a hysterectomy and were considered suitable for V-NOTES hysterectomy under spinal anaesthesia were included in this study. Spinal anaesthesia was achieved with 12.5 mg 0.5% hyperbaric bupivacaine in the sitting position. Perioperative events and complications related to spinal anaesthesia were noted. Postoperatively, the pain was evaluated using a visual analogue scale at the 6th, 12th, and 24th hours. Main outcome measures: To evaluate the feasibility and safety of spinal anaesthesia in VNOTES hysterectomy and to increase the advantages of minimally invasive surgical procedures. Results: No conversion to conventional laparoscopy or laparotomy was required in all six operated patients. Conversion from spinal anaesthesia to general anaesthesia was unnecessary, and no major perioperative incident occurred in any of the cases. Conclusion: In the current study by our team, we demonstrated that V-NOTES hysterectomy could be performed safely under spinal anaesthesia in well-selected patients. The need for additional analgesics can be reduced by utilising early postoperative analgesic effects of spinal anaesthesia, and maximum benefit can be obtained from minimally invasive approaches when VNOTES surgery is performed under spinal anaesthesia. What is new? V-NOTES hysterectomy could be performed safely under spinal anaesthesia in well-selected patients.

A New and Alternative Route: Transvaginal Natural Orifice Transluminal Endoscopic Scarless Surgery (vaginal natural orifice transluminal endoscopic surgery) For Class 2 and Class 3 Obese Patients Suffering From Benign and Malignant Gynecologic Pathologies

Background. This study was conducted to investigate the effectiveness of vaginal natural orifice transluminal endoscopic surgery (vNOTES) gynecologic scarless surgery in benign and malignant class 2 and class 3 obese patients. Materials and methods. The class 2 and class 3 obese women undergoing vNOTES scarless surgery for benign and malign indications at a tertiary referral medical center between January 2019 and April 2021 were retrospectively analyzed and surgical outcomes were measured. Results. In this study, 81 class 2 and class 3 obese patients underwent gynecological procedures using vNOTES scarless surgery. Of the 81 operations, 55 of the class 2 obese patients with benign pathologies, and 26 of the class 3 obese patients had malign pathologies. No conversion to conventional laparoscopy or even laparotomy was needed in any of the procedures. All of the surgeries were performed by the same surgeon (Prof. Dr Ahmet Kale). vNOTES scarless surgery was performed on 26 class 3 obese patients with malign pathologies. Of the 26 class 3 obese patients, 22 of the class 3 obese patients with early-stage endometrial carcinoma had very high mean body mass index 41.5 kg/m2 (range 20.6-56) and 4 of the class 3 obese patients had ascites with unknown cause and diagnosed with peritoneal carcinomatosis. The mean postoperative pain VAS scores of class 2 obese patients undergoing vNOTES scarless surgery with benign pathology at 6, 12, and 24 h were 3.19, 1.11, and .66, respectively, and the mean postoperative pain VAS scores of class 3 obese patients underwent vNOTES scarless surgery with malign pathology at 6, 12, and 24 h were 3.30, 1.76, and 1.03, respectively. Conclusion. vNOTES scarless surgery is an alternative surgical method for diagnosis and treatment not only in benign obese cases, but also in severely obese patients with early stage endometrial cancer and patients had with ascites with unknown cause. In the near future, vNOTES scarless surgery will become more preferable by experienced surgeons in benign and malignant obese cases as it has increased satisfaction with esthetic results such as less pain, and improved postoperative quality of life in the short and long term.

Hearing test results of newborns born from the coronavirus disease 2019 (COVID-19) infected mothers: A tertiary center experience in Turkey

Objective

Congenital infections can cause newborn hearing loss. Although vertical transmission of coronavirus disease 2019 (COVID‐19) infection is theoretically possible, this has not been proven yet. To our knowledge, there is no previous report on whether COVID‐19 infection during pregnancy can cause congenital hearing loss. This paper aimed to find an answer to this question.

Method

This retrospective, single‐center study was performed between April 2020 and May 2021 at a tertiary care referral center in Turkey. A total of 422 pregnant women who had coronavirus infection during pregnancy were followed and 203 of them gave birth in our institution. Results of hearing screening tests of 199 newborns were assessed retrospectively.

Results

Of patients included in the study, 23 (11.6%) had the disease in the first trimester, 62 (31.2%) in the second trimester, and 114 (57.3%) in the third trimester. In the first hearing test performed on newborns, unilateral hearing loss was observed in 21 babies (10.5%). Hearing tests of these newborns were found to be normal in the second test performed 15 days later.

Conclusion

Considering the incidence of congenital hearing loss, the absence of hearing loss in our newborn population does not confirm the argument that coronavirus infection does not cause congenital hearing loss. This issue should be evaluated with larger patient series. In addition, it should be kept in mind that hearing loss can occur at later ages as well.

Laparoscopic surgical approach for the treatment of piriformis syndrome: Intrapelvic decompression technique

Introduction:

Piriformis syndrome is an uncommon disease resulting from the piriformis muscle’s compression of the sciatic nerve. Pain and numbness in the buttocks and down the leg are the most common symptoms. This study analyzes the laparoscopic surgical treatment of piriformis syndrome.

Methods:

We report three cases of piriformis syndrome diagnosed in our hospital. The first case was a 40 years old woman with a 7-year history of intermittent low back pain and sciatica on her right side. Hyperesthesia and cutaneous allodynia were observed in the right sciatic nerve dermatome. The second case was a 30 years old woman with a 2-year history of sciatica on her left side. The third case was a 30 years old woman with a 2-year history of sciatica on her right side. All the patients underwent laparoscopic decompression surgery, which was performed to release the sciatic nerve or sacral nerve roots.

Results:

The patients were reexamined at the postoperative 3rd and 6th months. Their visual analog scale (VAS) scores were found to be decreased from 10/10, 9/10, and 7/10 to 0/10, 1/10, and 0/10, respectively.

Conclusion:

Due to the very few cases in the literature, pelvic piriformis syndrome is an exclusively clinical diagnosis. If the sciatica is refractory to conservative treatments, laparoscopic exploration and decompression surgery of the pelvic nerves and piriformis muscle could be an option.

Alternative method for the diagnosis of acid cases of unknown cause: Transvaginal natural orifice transluminal endoscopic surgery

AIM

To evaluate the efficacy and reliability of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) technique in making the diagnosis of ascites with unknown cause.

METHODS

Seven patients with ascites with unknown cause and diagnosed with vNOTES between November 2018 and May 2019 were analyzed retrospectively. The following data were collected retrospectively: body mass index, age, parity, previous abdominal or pelvic surgery, total operating time, perioperative complications and visual analog scale scores for evaluation of postoperative pain. After general anesthesia and disinfection, a 2-3 cm incision was made in the posterior fornix of the vagina. In all of the vNOTES procedures, a handmade glove port system comprised of a glove-wound retractor NOTES port was used.

RESULTS

Transvaginal natural orifice transluminal endoscopic surgery for diagnostic peritoneoscopy was successfully performed in seven patients. Following postoperative pathological examination; three patients were established to have peritoneal carcinomatosis, one patient abdominal tuberculous, one patient ovarian fibroma, one patient ovarian mature cystic teratoma and one patient stomach cancer. In 1-year follow-up period after vNOTES procedure, no adverse events occurred in patients.

CONCLUSION

In making histological diagnosis of ascites with unknown cause, vNOTES is a feasible, safe and efficient technique. Due to its high performance in diagnosis, this technique helps to initiate treatment early in some diseases in addition to preventing unnecessary treatment and examination in benign diseases. Besides, via obtaining a detailed and enlarged image of abdominal cavity, this procedure also guides the clinician in the evaluation of the suitability of patient for operation.

Hysterectomy and salphingoopherectomy by Transvaginal Natural Orifice Transluminal Endoscopic Surgery(NOTES): Turkish surgeons' initial experience

BACKGROUND

The aim of this study was to evaluate the feasibility, safety, and early postoperative outcomes of hysterectomies and salpingo-oophorectomies using transvaginal natural orifice transluminal endoscopic surgery (vNOTES).

MATERIALS AND METHODS

The women undergoing vNOTES hysterectomies and salpingo-oophorectomies at a tertiary referral medical center between April 2016 and April 2017 were retrospectively analyzed. In all of the vNOTES procedures, a handmade glove port system comprised of a glove-wound retractor NOTES port was used.

RESULTS

Thirteen patients underwent gynecological procedures with benign indications via vNOTES. Of the 13 operations, 6 of the patients had salpingo-oophorectomies and 7 had hysterectomies, and all of the surgeries were performed by the same surgeon (Dr. Ahmet Kale). No conversion to a conventional laparoscopy or even a laparotomy was needed in any of the procedures. The mean operation time was 73.14 min in the hysterectomy patients and 40.8 min in the salpingo-oophorectomy patients. The mean drop in the hemoglobin (Hb) level was 1.4 g/dl in the hysterectomy patients and 1.6 g/dl in the salpingo-oophorectomy patients. For these patients undergoing vNOTES, the mean postoperative visual analog scale (VAS) pain score at 6 h was 4.38 and at 24 h it was 0.62. There were no intraoperative complications in any of the cases. The mean length of the hospital stay was 1.8 days in the hysterectomy patients and 1.5 days in the salpingo-oophorectomy patients.

CONCLUSION

The vNOTES procedure overcomes the surgical and technical difficulties of conventional vaginal surgery by incorporating the advantages of endoscopic surgery. Moreover, vNOTES uses inexpensive, reusable, handmade conventional laparoscopic instruments and avoids those problems related to abdominal wall incisions and trocar-related complications. Overall, this procedure results in high patient satisfaction, cosmetic advantages, and decreased postoperative pain.