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Lorenzo GD, Mirenda G, Gentile RM, Pozzolo CD, De Santo D, Romano F, Ricci G. Use of Indocyanine Green to Evaluate Ovarian Perfusion After Laparoscopic Detorsion. A Step-By-Step Demonstration Video. J Minim Invasive Gynecol 2024; 31:269-270. [PMID: 38244720 DOI: 10.1016/j.jmig.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/01/2024] [Accepted: 01/12/2024] [Indexed: 01/22/2024]
Abstract
OBJECTIVE Demonstrate the usefulness of using indocyanine green after laparoscopic ovarian detorsion to save the ovary. DESIGN A step-by-step video demonstration of a surgical technique. SETTING Ovarian torsion is one of the most common gynecological emergencies, mainly affecting patients younger than 20 years of age [1], and causes 2% to 7% of acute abdomens [2]. It is not advisable to routinely perform ovariectomy even with a necrotic ovary appearance [1]. Furthermore only in a small percentage of cases (16%) necrosis has been confirmed histologically [2]. Some studies have demonstrated that using indocyanine green to evaluate ovarian perfusion is inexpensive, low risk, and easily reproducible [3-5]. INTERVENTIONS A 17-year-old patient was referred to our hospital for acute abdominal pain. Ultrasound revealed ovarian torsion; therefore, the patient underwent surgical treatment. During laparoscopy, the presence of a right ovarian torsion was confirmed. A lesion compatible with a hemorrhagic corpus luteum of 6 cm was present on the ovary affected. Before ovarian detorsion, indocyanine green was administered intravenously at a 0.5 mg/kg dose. The first aspect noted was the total lack of ovarian vascularization; then ovarian detorsion was performed. At this point, using technology of Rubina (KARL STORZ SE & Co. KG, Tuttlingen, Germany), it was possible to highlight the progressive ovarian revascularization. Ovarian reperfusion occurred starting from the ovarian hilum and ending at the periphery. We proceeded with enucleation of the hemorrhagic corpus luteum by stripping technique, with subsequent ovarian reconstruction with continuous 2-0 monofilament suture. Finally, we fixed the ovary to the stump of the right round ligament. The final view highlights good ovarian vascularization. No complications occurred; the patient was discharged on the first postoperative day. A 6-month follow-up ultrasound confirmed the recovery of the vascularization of ovary. CONCLUSION Using indocyanine green represents a valid option to evaluate ovarian perfusion after detorsion. It could help the surgeon decide to save the ovary and thus allow fertility-sparing surgery in more cases.
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Affiliation(s)
- Giovanni Di Lorenzo
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy (Drs. Di Lorenzo, Mirenda, Davide, Romano, and Ricci)
| | - Giuseppe Mirenda
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy (Drs. Di Lorenzo, Mirenda, Davide, Romano, and Ricci).
| | - Roberta Marie Gentile
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy (Drs. Gentile, Dal Pozzolo, and Ricci)
| | - Chiara Dal Pozzolo
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy (Drs. Gentile, Dal Pozzolo, and Ricci)
| | - Davide De Santo
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy (Drs. Di Lorenzo, Mirenda, Davide, Romano, and Ricci)
| | - Federico Romano
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy (Drs. Di Lorenzo, Mirenda, Davide, Romano, and Ricci)
| | - Giuseppe Ricci
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy (Drs. Di Lorenzo, Mirenda, Davide, Romano, and Ricci); Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy (Drs. Gentile, Dal Pozzolo, and Ricci)
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Shaw TB, Ma B, Barazza M, Sawaya D. Surgical Control of Bleeding From Ovarian Torsion in the Setting of Immune Thrombocytopenic Purpura Without Splenectomy. Am Surg 2023; 89:4884-4887. [PMID: 33866863 DOI: 10.1177/00031348211011128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Immune thrombocytopenic purpura (ITP) is a disorder caused by autoimmune antibodies which target glycoprotein IIb/IIIa complex or other platelet membrane antigens leading to platelet destruction. These platelets are then cleared by the spleen resulting in thrombocytopenia. Immune thrombocytopenic purpura affects about 1 to 6.4 cases in 100 000 children making it one of the most common causes of symptomatic thrombocytopenia in the pediatric population. It is rare that children or adolescents present with serious bleeding due to ITP. Common presentations include petechiae, bleeding gums, or bruising. Bleeding requiring hospitalization or transfusions is unusual and only occurs in approximately 5% of children. Even more uncommon is the presentation of severe bleeding complications requiring surgery for resolution. We present a case of a 17-year-old girl with acute ITP complicated by intraperitoneal hemorrhage and refractory thrombocytopenia due to ovarian cyst requiring oophorectomy.
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Affiliation(s)
- Taylor B Shaw
- Department of Surgery, University of Mississippi Medical Center, Jackson, MS, USA
| | - Brenda Ma
- Department of Surgery, University of Mississippi Medical Center, Jackson, MS, USA
| | - Mark Barazza
- Department of Surgery, Division of Pediatric Urology, University of Mississippi Medical Center, Jackson, MS, USA
| | - David Sawaya
- Department of Surgery, Division of Pediatric Surgery, University of Mississippi Medical Center, Jackson, MS, USA
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Hao J, Sun Z. Clinical characteristics of adnexal torsion and role of ovarian sparing surgery: a clinical retrospective analysis. Ginekol Pol 2023; 95:84-91. [PMID: 37861222 DOI: 10.5603/gpl.95324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/19/2023] [Accepted: 06/28/2023] [Indexed: 10/21/2023] Open
Abstract
OBJECTIVES To analyze the clinical characteristics and risk factors related to necrosis of adnexal torsion (AT) and improve the application of ovarian-sparing surgery (OSS). MATERIAL AND METHODS Data of 142 patients with 144 surgically confirmed AT lesions between October 2011 and December 2021 were retrospectively analyzed. RESULTS The risk of torsion caused by tumors was higher than that caused by tumor-like lesions (p = 0.003). The incidence of right adnexal necrosis was higher than that of left adnexal necrosis (p = 0.03). There were no significant differences in adnexal necrosis or onset time (p = 0.29) between groups. The main risk factor for adnexal necrosis was the degree of torsion with a threshold of 510°. The size of adnexal mass and the degree of torsion increased linearly with age. The OSS rate was 59.7% for all patients, and 71.6% in the premenopausal women. No serious complications occurred in any of the patients. CONCLUSIONS Age, histopathological type, adnexal size, degree of torsion, and pelvic anatomical structure are risk factors for AT and adnexal necrosis. There is no infinite correlation between adnexal necrosis and onset time. Adnexal size is the main risk factor for AT, and along with the risk of adnexal necrosis, increases with age. The degree of torsion is the main risk factor for adnexal necrosis, and torsional severity increases with age. OSS is safe and does not increase the incidence of postoperative complications.
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Affiliation(s)
- Jing Hao
- Department of Gynaecology, Affiliated Weihai Municipal Hospital, Shandong University, Weihai, China, China
| | - Zhihuan Sun
- Department of Gynaecology, Affiliated Weihai Municipal Hospital, Shandong University, Weihai, China, China.
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Yu M, Liu Y, Jia D, Tian T, Xi Q. Adnexal torsion in pregnancy after in vitro fertilization: Case report and literature review. Medicine (Baltimore) 2021; 100:e24009. [PMID: 33545996 PMCID: PMC7837920 DOI: 10.1097/md.0000000000024009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 12/03/2020] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Torsion is the most common gynecologic emergency of the adnexal mass occurring during pregnancy. We report the clinical data of a case of twin pregnancy with adnexal torsion after in vitro fertilization (IVF) and embryo transfer, in which the patient underwent surgery for adnexal detorsion and experienced preterm delivery. One child died as a neonate, and the other child was diagnosed with hematological disease, which, to our knowledge, has not been reported previously. We also performed a systematic literature review to increase knowledge of the need for prompt surgical intervention. PATIENT CONCERNS The patient was a 32-year-old pregnant woman, who presented to our center with acute onset of stabbing and non-radiating continuous lower left abdominal pain after urination, of 6 hours duration. DIAGNOSIS Physical examination revealed that the lower abdominal tenderness was worse on the left side, and there were no signs of peritonitis. Transvaginal ultrasonographic examination indicated a multiloculated left ovary measuring 12.1 × 7.1 cm with sparse blood flow. The size of the largest cyst was 7.2 × 6.6 cm, the right ovary appeared normal, and two live fetuses were seen. INTERVENTIONS laparoscopy was performed 1.5 hours later, which revealed a cystic and multilocular left ovary with a black purplish surface and thin wall. The left ovary and left fallopian tube had undergone 720° torsion (3 rotations), and detorsion was performed laparoscopy. OUTCOMES The left adnexa recovered to near normal appearance 20 minutes postoperatively. The patient was discharged from hospital 5 days postsurgery, without complications. Unfortunately, the patient delivered two preterm babies at 30 weeks of gestation. CONCLUSIONS We should be alert to the possible risk of adnexal torsion in pregnant women after IVF. Adnexal torsion necessitates prompt surgical intervention, detorsion and preserving ovarian function are the main treatment methods. Furthermore, the possibility of recurrence, and pregnancy outcomes for the patient, as well as newborn health, should be considered.
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Ozceltik G, Yeniel AO, Atay AO, Itil IM. Simplified two-step technique for transvaginal natural orifice transluminal endoscopic surgery. Fertil Steril 2020; 114:665-666. [PMID: 32660724 DOI: 10.1016/j.fertnstert.2020.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/02/2020] [Accepted: 05/05/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To describe our simplified two-step technique for transvaginal natural orifice transluminal endoscopic surgery (vNOTES) and to demonstrate the application of the technique. DESIGN Step-by-step description of the technique and demonstration of its application using surgical video footage from two different cases. SETTING Tertiary university hospital. PATIENT(S) Patient 1 was a 27-year-old G0P0 woman who presented with right lower quadrant pain. Transvaginal ultrasound scan revealed a right ovarian torsion. Patient 2 was a 25-year-old G3P2 woman. She presented with vaginal bleeding and left lower quadrant pain. Her serum β-human chorionic gonadotropin level was 28,313 U/L, and transvaginal ultrasound scan revealed an ectopic pregnancy in the left tube. The decision to perform vNOTES was made for both patients. INTERVENTION(S) As the first step, patients underwent diagnostic vNOTES. The patient was placed in lithotomy position under general anesthesia. By use of a 5-mm trocar with autoretracting blade, a colpotomy was performed on the posterior vaginal wall. Pneumoperitoneum was achieved, and the patient was placed in a Trendelenburg position. A 5-mm 30° rigid endoscope was introduced, and the diagnosis was confirmed. After the confirmation of the diagnosis, we proceeded to the second step. The colpotomy was enlarged with blunt dissection by using Metzenbaum scissors. A self-constructed pessary port was placed through the colpotomy, and pneumoperitoneum was achieved. The therapeutic procedure was then performed. Patient 1 underwent ovarian detorsion with a 5-mm laparoscopic grasper. After the ovary was detorsioned, a 5-mm bipolar instrument was used to achieve hemostasis. Patient 2 underwent left salpingectomy with a 5-mm advanced bipolar device. Hemostasis was verified, and the specimen was extracted through the colpotomy. Procedures ended with the closure of colpotomy with running resorbable sutures. MAIN OUTCOME MEASURE(S) Description of the technique and demonstration of its applicability in two common gynecological emergencies. RESULT(S) Both patients were treated successfully by vNOTES. The operating times were 25 minutes and 38 minutes for patient 1 and patient 2, respectively. Patients were discharged on postoperative day 1 without any complications. CONCLUSION(S) Our simplified two-step technique described and demonstrated in this video article is a feasible and practical approach to perform vNOTES. The first step allows the confirmation of the diagnosis and facilitates the colpotomy. The use of the self-constructed pessary port enables to perform surgery with already existing equipment without the need for specialized equipment and without increasing the costs.
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Affiliation(s)
- Gokay Ozceltik
- Department of Obstetrics and Gynecology, Ege University Faculty of Medicine, Izmir, Turkey.
| | - Ahmet Ozgur Yeniel
- Department of Obstetrics and Gynecology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Arif Onur Atay
- Department of Obstetrics and Gynecology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Ismail Mete Itil
- Department of Obstetrics and Gynecology, Ege University Faculty of Medicine, Izmir, Turkey
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Winton C, Yamoah K. Ovarian torsion and laparoscopy in the paediatric and adolescent population. BMJ Case Rep 2020; 13:e232610. [PMID: 32404320 PMCID: PMC7228144 DOI: 10.1136/bcr-2019-232610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2020] [Indexed: 11/03/2022] Open
Abstract
A 9-year-old girl attended the emergency department with right-sided abdominal pain and vomiting. Due to history and following examination, an ultrasound was requested which demonstrated a large complex midline mass. The most likely diagnosis was ovarian torsion, for which the patient underwent laparoscopy, detorsion and ovarian cystectomy. Histology revealed a mature cystic teratoma. Although less common than in the adult population, it is important to consider ovarian torsion in children and adolescents. Presentation is usually with pain accompanied by vomiting and fever, although these symptoms are not always present. Current management is organ-sparing, with laparoscopy±cystectomy. We discuss the adaptations for this procedure with regard to the paediatric and adolescent population. Differences in the anatomy and physiology must lead to consideration for alterations in surgical technique and positioning to ensure the safest and best quality care for these young patients.
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Affiliation(s)
- Claire Winton
- Obstetrics and Gynaecology, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - Kofi Yamoah
- Obstetrics and Gynaecology, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
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KARAKAŞ S, KAYA C, GÜRASLAN H, SAKIZ D, SÜZEN ÇAYPINAR S, CENGİZ H, EKİN M, YAŞAR L. Effect of metformin and detorsion treatment on serum anti-Müllerian hormonelevels and ovarian histopathology in a rat ovarian torsion model. Turk J Med Sci 2020; 50:455-463. [PMID: 31999406 PMCID: PMC7164755 DOI: 10.3906/sag-1803-196] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 01/29/2020] [Indexed: 12/31/2022] Open
Abstract
Background/aim Adnexal torsion is a common gynaecological emergency, and considered to be a problem mostly in reproductive-age women. To evaluatethe effect of metformin and detorsion treatment on reducing ovarian reserve in an ovarian torsion model. Materials and methods Twenty-four nonpregnant, Wistar Hannover rats were included in the study. Animals were divided into 3 groups: the control group, the detorsion only group, and the metformin + detorsion group. The first group received only laparotomy. In the second group, ovaries were fixed to the abdominal wall after performing 360° ovarian torsion, followed by detorsion after a 3-h period of ischemia. The third group underwent the same torsion and detorsion procedures as the second group, and received 50 mg/kg metformin by gavage for 14 days. Ovarian damage scores, follicle counts, and AMH levels were evaluated. Results The total damage score was significantly increased in the detorsion only group compared to the metformin+detorsion and control groups. Pre-operative/post-operative AMH decreases were statistically significant in negative direction in the detorsion only group when compared to the metformin+detorsion and control groups (P = 0.001). Conclusion Metformin+detorsion treatment may be effective in protecting the ovarian reserve after ovarian torsion.
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Affiliation(s)
- Sema KARAKAŞ
- Department of Obstetrics and Gynecology, University of Health Sciences,Gaziosmanpaşa Taksim Training and Research Hospital, İstanbulTurkey
| | - Cihan KAYA
- Department of Obstetrics and Gynecology, University of Health Sciences,Bakirköy Dr. Sadi Konuk Training and Research Hospital, İstanbulTurkey
| | - Hakan GÜRASLAN
- Department of Obstetrics and Gynecology, University of Health Sciences,Bakirköy Dr. Sadi Konuk Training and Research Hospital, İstanbulTurkey
| | - Damlanur SAKIZ
- Department of Pathology, University of Health Sciences,Bakirköy Dr Sadi Konuk Training and Research Hospital, İstanbulTurkey
| | - Sema SÜZEN ÇAYPINAR
- Department of Obstetrics and Gynecology, University of Health Sciences,Bakirköy Dr. Sadi Konuk Training and Research Hospital, İstanbulTurkey
| | - Hüseyin CENGİZ
- Department of Obstetrics and Gynecology, University of Health Sciences,Bakirköy Dr. Sadi Konuk Training and Research Hospital, İstanbulTurkey
| | - Murat EKİN
- Department of Obstetrics and Gynecology, University of Health Sciences,Bakirköy Dr. Sadi Konuk Training and Research Hospital, İstanbulTurkey
| | - Levent YAŞAR
- Department of Obstetrics and Gynecology, University of Health Sciences,Bakirköy Dr. Sadi Konuk Training and Research Hospital, İstanbulTurkey
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Dvash S, Pekar M, Melcer Y, Weiner Y, Vaknin Z, Smorgick N. Adnexal Torsion in Pregnancy Managed by Laparoscopy Is Associated with Favorable Obstetric Outcomes. J Minim Invasive Gynecol 2019; 27:1295-1299. [PMID: 31563614 DOI: 10.1016/j.jmig.2019.09.783] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/19/2019] [Accepted: 09/20/2019] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVE Most cases of adnexal torsion in pregnancy are currently managed by laparoscopy, which may be associated with increased risks for spontaneous abortion and preterm delivery. We sought to evaluate the obstetric outcomes of these women, with emphasis on their live birth rate and gestational age at delivery. DESIGN Retrospective cohort study and telephone questionnaire. SETTING University-affiliated obstetrics and gynecology department. PATIENTS All pregnant women who underwent laparoscopy for adnexal torsion between 2007 and 2017. Their obstetric outcomes were obtained by retrospective review of medical records and a telephone questionnaire. INTERVENTIONS Laparoscopy for adnexal detorsion, with or without cyst drainage or cystectomy. MEASUREMENTS AND MAIN RESULTS The study cohort included 94 women. Most torsion cases (71, 75.5%) were diagnosed in the first trimester of pregnancy, whereas 21 (22.3%) cases and 2 (2.1%) cases were diagnosed in the second and third trimesters, respectively. Conception was achieved by in vitro fertilization or by ovulation induction in 45 (47.9%) cases. The information on pregnancy outcomes was available for 93 women. Of those, live birth was reported for 86 (92.5%) pregnancies, while 6 (6.5%) women had a spontaneous abortion, and 1 woman experienced an intrauterine fetal death. Five cases of spontaneous abortion were diagnosed in the first trimester, all within 3 weeks of surgery. Preterm delivery before 37 gestational weeks was reported for 18 (19.4%) pregnancies and was significantly associated with twin pregnancy (p = .002) and with conception following in vitro fertilization and ovulation induction (p = .03). On logistic regression analysis, preterm delivery was only associated with twin vs singleton gestation (odds ratio, 6.7; 95% confidence interval, 1.3-34.8; p = .02). CONCLUSION The obstetric outcomes of pregnant women who underwent laparoscopy for adnexal torsion are generally favorable. However, there is a risk for preterm delivery, which is primarily associated with multiple gestations.
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Affiliation(s)
- Shira Dvash
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (all authors)
| | - Marina Pekar
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (all authors)
| | - Yaakov Melcer
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (all authors)
| | - Yifat Weiner
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (all authors)
| | - Zvi Vaknin
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (all authors)
| | - Noam Smorgick
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (all authors)..
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