Cerrahi kongresi kongre biLİmsel programi ve biLDİRİ Özetleri

 www.minimalinvazivjinekolojikcerrahi.org
21 - 25 Şubat 2018
Wyndham Grand İstanbul Levent • İstanbul
MİNİMAL İNVAZİV JİNEKOLOJİK
CERRAHİ KONGRESİ
SS-03 
A new method used in laparoscopic hysterectomy for uterine manipulation: “Uterine Rein 
Technique’’
Abdullah Boztosun
1
, Remzi Atılgan
2
, Şehmus Pala
2
, Şafak Olgan
1
 
1
Department of Obstetrics and Gynecology, Akdeniz University, Antalya, Turkey 
2
Department of Obstetrics and Gynecology, Firat University, Elazig, Turkey
OBJECTIVE: The current study aimed to describe a novel technique allowing abdominal 
manipulation of the uterus during laparoscopic hysterectomy. 
 
MATERIALS-METHODS: Total laparoscopic hysterectomy with newly defined technique was 
performed in 29 patients between July 2016 and July 2017. Preparation of polyester tape was 
described in Figure 1. The pre-operatively prepared tape was inserted into the intraabdominal 
cavity after ligation of infundibulopelvic and round ligaments (before ligating uterine arteries). 
After being wrapped around uterus at a location just above corpus-isthmus level, both ends of 
tape A were tied anteriorly. Subsequently, one of the free ends of tape A was passed through 
the ring of tape B at uterine fundus level and tied with the other free end of tape A. Finally, 
after being checked for the position and tightness, the remaining free ends of tape A were cut 
and taken out through port site. After this stage, manipulation of the uterus was performed by 
grasping of the polyester tape (Figure 1-3).
 
RESULTS: Technique was successfully performed in a single attempt in 93.1% of cases. Uterine 
tape released in two cases (6.9%) with myoma uteri and thus the procedure had to be repeated. 
The mean application time was 11.2 minutes (min-max, 7-25 minutes). The mean operation 
duration was 120 minutes (min-max, 40-200 minutes). Vaginal manipulator was not required in 
any of the cases. There were no intraoperative or postoperative major complications within the 
mean follow-up period of 6 months.
 
CONCLUSION: Our technique has several advantages including no need for any vaginal 
manipulator, reduced number of assistants required during operation, allowing near maximum 
manipulation of uterus in all three dimensions, and enable the surgeons to control the 
manipulations directly. Finally, our preliminary results on the use of uterine rein technique are 
promising and justify further investigation in larger prospective studies.
 
Keywords: laparoscopic hysterectomy, uterine manipulator, uterine rein technique 
 
 

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21 - 25 Şubat 2018
Wyndham Grand İstanbul Levent • İstanbul
MİNİMAL İNVAZİV JİNEKOLOJİK
CERRAHİ KONGRESİ
 www.minimalinvazivjinekolojikcerrahi.org
figure 1 
 
Two pieces of a polyester tape, 50 cm (A) and 25 cm (B), were used for this procedure. Both ends of 
the tape B were tied to the middle of the tape A within 2 cm distance. Then, by tying a simple knot on 
the unbound free end of tape B, an additional circle (C) was generated (1-2 cm diameter) which was 
going to be used to restrain the uterus. 
 
figure2 
 
Manipulation of uterus by grasping the polyester tape 
 
 
figure3 
 
Manipulation of uterus by grasping the polyester tape 

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 www.minimalinvazivjinekolojikcerrahi.org
21 - 25 Şubat 2018
Wyndham Grand İstanbul Levent • İstanbul
MİNİMAL İNVAZİV JİNEKOLOJİK
CERRAHİ KONGRESİ
SS-04 
The effect of the levonorgestrel-releasing intrauterine device used in the abnormal 
uterine bleeding treatment related to uterine leiomyomas on uterine artery blood flows, 
leiomyoma size and uterine volume
Hatice Kansu Çelik 
Zekai Tahir Burak Woman’s Health, Education and Research Hospital, Health Science University, 
Ankara, Turkey
OBJECTIVES: A prospective cohort study was carried out to evaluate uterine volume, uterine 
leiomyoma size, uterine artery blood flows in women using the levonorgestrel intrauterine 
system (LNG-IUS) to treat abnormal uterine bleeding related to leiomyomas.
 
MATERIALS-METHODS: 30 premenopausal women attending our gynecology clinic due 
to abnormal uterine bleeding related to uterine myomas were enrolled into the study. The 
age, gravidity, body mass index (BMI) and menstrual flow pattern using a Pictorial Blood Loss 
Assessment Chart (PBAC) score were recorded. All women were assessed by ultrasonography 
at the preinsertion period and 6 months after insertion. The pulsatility and resistance indices (PI 
and RI, respectively) of the uterine artery, endometrial thickness, uterine volume, and leiomyoma 
size were evaluated in the preinsertion and postinsertion periods.
 
RESULTS: 2 patients underwent spontaneous expulsion of the device after 1 and 2 months 
of follow-up. The mean age of the patients was 47.36+/-2.16 years. At 6 months follow-up, 2 
women had a hysterectomy. 3 patients were amenorrheic (Tabel 1). The PBAC score and 
the mean endometrial thickness were decreased 6 months after insertion; these decreases 
were statistically significant (p<0.001). Also, the hemoglobin level was increased (p=0.001). A 
reduction in mean uterine volume and leiomyoma size, and an increase in mean uterine artery PI 
were observed, but these changes did not reach statistical significance (p = 0.654, p=0.509 and 
p = 0.07, respectively) (Table 2).
 
CONCLUSIONS: LNG-IUS seems to reduce menstrual blood loss, endometrial thickness with 
no change in the blood flow in the uterine artery. Also, it increases hemoglobin levels in the 
premenopausal women with uterine leiomyomas even in the absence of reduction of uterine 
and leiomyoma volume.
 
Keywords: Levonorgestrel intrauterine system, Doppler flow, Leiomyoma, Abnormal uterine 
bleeding, Ultrasonography 
 
 

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