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    Biliary Cystadenoma with High Dysplasia Detected Incidentally in a Young Patient Admitted for Percutaneous Abscess Drainage
    (Kare Publ, 2023) Gonen, Korcan Aysun; Sasani, Hadi; Acar, Sami; Dulundu, Ender
    Biliary cystadenomas are uncommon lesions with clinical and radiological characteristics that overlap with other cystic liver lesions. Here, we intended to discuss a biliary cystadenoma found in a 37 -year -old female patient who had been treated for a liver abscess and had been sent to our clinic with a long-term hydatid cyst diagnosis.
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    Clinical and reproductive outcomes of uterine smooth muscle tumor of uncertain malignant potential (STUMP): A tertiary center experience
    (Ondokuz Mayis Universitesi, 2023) Akis, Serkan; Öztürk, Uğur Kemal; Acar, Sami; Çiftçi, Erman; Api, Murat
    Some smooth muscle tumors do not meet the histologic criteria for definite benign-malignant distinction and this rare group is thus classified as smooth muscle tumors of uncertain malignant potential (STUMP). Due to the high heterogeneity, there are no standard guidelines for the diagnosis, treatment, and follow-up of uterine STUMPs. So, we aimed to evaluate the treatment modalities in patients with/without fertility desires. The size, mitotic count, presence of necrosis and atypia of tumors were obtained from the final pathology reports. Patients were followed up with electronically merged records via telephone until October 2022. Recurrence, time to recurrence, and recurrence histopathology were included in the study. Myomectomy was performed in 50% of the patients. Frozen section was not considered necessary in 57.1% of all patients and 50% of the patients who underwent frozen section were reported as benign. The median follow-up was 64.5 months. Tumor necrosis was observed in 14.3% of patients. The median mitosis count was calculated as 2.5 (1-9) per 10 high-power fields. The recurrence rate was calculated to be 7.2%. The accuracy of a frozen section diagnosis may not always be reliable, it is often confirmed after the final pathology has been reported. Patients who desire fertility can be supported. Our research indicates that recurrence rates could be lower in centers where experienced pathologists are making the diagnosis. © 2023 Ondokuz Mayis Universitesi. All rights reserved.
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    Transvaginal morcellation within an enclosed bag in gynecological surgeries: a comprehensive systematic review and analysis of safety, efficacy, and outcomes
    (Springer Science and Business Media Deutschland GmbH, 2024) Alomari, Omar; Mokresh, Muhammed Edib; Muvaffak, Emir; Bakir, Rahime Nurbanu; Al Shomali, Raghad; Akis, Serkan; Acar, Sami
    Purpose: This systematic review aims to comprehensively assess the safety and efficacy of transvaginal morcellation within an enclosed bag in gynecological surgeries, with a focus on its benefits, potential risks, and recommendations for its use. Methods: We conducted a comprehensive search of Epistemonikos, Web of Science, Medline (PubMed), Scopus, and Cochrane databases for studies on transvaginal contained morcellation in adult patients undergoing gynecological surgeries. The review included 22 studies that met the inclusion criteria, encompassing diverse surgical procedures, patient profiles, and outcomes. These studies were thoroughly reviewed and analyzed to assess the safety and efficacy of the morcellation technique. Results: Key findings from the selected studies indicate that transvaginal morcellation within an enclosed bag offers several advantages in gynecological surgeries, including reduced invasiveness, shorter operative times, and minimal blood loss when compared to conventional methods. The risk of tumor recurrence or dissemination appears to be low when appropriate precautions are taken, emphasizing the technique’s safety, especially when performed by experienced surgical teams. While some studies reported complications, these were generally not directly associated with the morcellation technique. Conclusion: Transvaginal morcellation within an enclosed bag demonstrates potential as a safe and effective option for gynecological surgeries. The technique offers the benefits of minimally invasive procedures, including reduced bleeding, shorter recovery times, and improved cosmetic outcomes. This review also highlights the need for standardization in study methodologies and reporting, as the heterogeneity in outcomes across the selected studies poses challenges in drawing definitive conclusions. © The Author(s) 2024.
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    Two Port and Two Suture Modified Laparoscopic Cholecystectomy Technique
    (Galenos Publ House, 2023) Acar, Sami; Sahbaz, Nuri Alper
    Aim: Laparoscopic cholecystectomy is the gold standard method for the treatment of gallstone disease. In this study, the two-port laparoscopic cholecystectomy technique was described. Materials and Methods: The inclusion criteria were having current or past biliary colic, risk of developing gallbladder cancer, porcelain gallbladder, gallbladder polyp larger than 5 mm, and asymptomatic large gallbladder stones (>20 mm). The exclusion criteria were determined as having a suspicious malignancy, an American Society of Anesthesiologists score of 4 or 5, diagnosis of choledocholithiasis, a history of endoscopic retrograde cholangiopancreatography, past intra-abdominal surgery, and a body mass index >33 kg/m(2). Results: Two-port laparoscopic cholecystectomy was performed in 48 patients. Eleven patients (22.9%) were operated on with a preliminary diagnosis of cholecystitis and 37 patients (77.1%) with a prediagnosis of cholelithiasis. While 39 (81.2%) patients had multiple stones in the gallbladder, 9 (18.8%) had a single stone. The mean gallbladder wall thickness was 4.3 +/- 1.7 mm (range 2-10 mm), and the mean stone diameter was 14.0 +/- 10.2 mm (range 2-40 mm). The mean operation time in the whole group was 63.4 (range 42-86) minutes. Complications developed in 3 (6%) patients, including 3 subcutaneous infections. Conclusion: For standard four -port cholecystectomy, the two-port and two-suture assisted technique is a good alternative for selected cases. It can be applied successfully and is cosmetically effective.