Cerrahi Tıp Bilimleri Bölümü Koleksiyonu

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Professional grief and the second victim experience in neurosurgery: An international cross-sectional study on professional sustainability and educational implications
(Elsevier, 2026) Şanlıer, Nafiye; Flora Göy, Defne; Sulaimanov, Umid; Moniri, Ariorad; Akbaş, İbrahim Halil; Ismayilova, Gular; Demir, Hüseyin; Öztürk, Öykü; Nizzola, Mariagrazia; Hatipoğlu Majernik, Gökçe
OBJECTIVE Adverse events are inevitable in neurosurgical practice and may have significant emotional and professional implications for surgeons. While second victim experiences have been increasingly recognized, the role of professional grief remains insufficiently characterized within the field of neurosurgery. This study aimed to examine professional grief as a component of the second victim experience and its associations with distress, support dimensions, educational needs, and professional sustainability. METHODS We conducted an international, cross-sectional, anonymous web-based survey among neurosurgeons and neurosurgical trainees. Professional grief related to a personally impactful adverse event was assessed retrospectively using the Professional Bereavement Scale-Short-term Bereavement Reactions Subscale (PBS-Acute); scores therefore reflect retrospectively recalled acute grief responses rather than contemporaneously measured reactions. Second victim dimensions were evaluated with the Second Victim Experience and Support Tool-Revised (SVEST–R). Associations among grief severity, second victim dimensions, and professional sustainability indicators were analyzed using correlation and multivariable regression. RESULTS Of 465 respondents from 49 countries, 314 completed the survey and were included in the analysis. A total of 240 participants (76.4%) reported a personally impactful adverse event. Professional grief severity was substantial among respondents (PBS-Acute mean 37.9 ± 13.8) and was strongly correlated with psychological distress (ρ = 0.71, p < 0.001). Higher grief severity was independently associated with increased turnover intention (β = 0.026, p < 0.001). Perceived preventability and primary surgeon role were associated with higher grief severity, while event timing and seniority were not. Supervisor support was inversely associated with grief severity. Participants reported substantial unmet educational needs related to medicolegal processes, communication with patient families, and grief coping skills. CONCLUSIONS Among surveyed neurosurgeons who described a personally impactful adverse event, professional grief was frequently reported. Professional grief in this sample was associated with second victim experiences, psychological distress, and indicators of professional vulnerability. These cross-sectional associations suggest that professional grief may warrant consideration in structured educational models and tiered support systems within neurosurgical training and institutional practice. Prospective work is needed to clarify the direction and durability of these relationships and their implications for professional sustainability.
Laparoscopic resection–rectopexy with natural orifice specimen extraction (NOSE): In a male with recurrent internal rectal prolapse—A video vignette
(Wiley, 2026) Arslan, Çiğdem; Yıldırım, Yasemin; Ermeç, Elif Diler; Erenler Bayraktar, İlknur
Laparoscopic sigmoid resection and suture rectopexy (LRR) is a well- established option for overt rectal prolapse; however, evidence for its role in internal rectal prolapse (IRP) and obstructed defecation syn drome (ODS) remains limited, and the potential impact on functional and sexual outcomes—particularly in young males—often prompts caution [1–3].
Long-term microbiome and clinical effects of a microbiome-guided personalized diet versus low-FODMAP diet in irritable bowel syndrome: A 12-month follow-up randomized controlled trial
(Taylor & Francis, 2026) Tunalı, Varol; Arslan, Çiğdem; Derviş Haki̇m, Gözde; Gündoğdu, Aycan; Ermi̇ş, Beyza Hilal; Hora, Mehmet; Nalbantoğlu, Özkan Ufuk
Dietary therapy is central to irritable bowel syndrome (IBS) management, yet the long-term durability of the low-FODMAP diet (LFD), and of microbiome-guided personalization, remains unclear. We assessed the long-term clinical and gut-microbiome effects of a microbiome-guided personalized diet (PD) compared with a standard LFD in adults meeting Rome IV criteria for IBS. In this multicenter, open-label randomized controlled trial with blinded outcome assessment, participants who completed a 6-week dietary intervention (PD or LFD) were followed at 6 and 12 months without further dietary intervention. Outcomes included the IBS Severity Scoring System (IBS-SSS), IBS Quality of Life (IBS-QOL), and the Hospital Anxiety and Depression Scale (HADS); gut microbiota were profiled by 16S rRNA sequencing. Longitudinal changes were evaluated using linear mixed-effects models, responder analyses, PERMANOVA, and PERMDISP. Both diets reduced IBS-SSS at 6 weeks. PD maintained symptom improvement at 6 and 12 months (−82.0 and −78.3 points from baseline), whereas LFD benefits regressed by 12 months (+29.3 points; between-group p = 0.001). At 12 months, IBS-SSS responder rates were higher with PD than LFD (62.5% vs 34.5%; absolute risk difference +28.0%, 95% CI 4.2–47.7; Fisher p = 0.029), and IBS-QOL, HADS-anxiety, and HADS-depression showed more favourable trajectories with PD. PD was associated with sustained Shannon alpha-diversity gains (+0.488 at 6 weeks; +0.205 at 12 months; both p < 0.01). A modest between-group beta-diversity difference at 6 months (R2 = 0.035; p = 0.011) was not significant at 12 months. This hypothesis-generating follow-up suggests more durable benefit with PD; larger trials powered for long-term clinical and microbiome outcomes are warranted.
A clinical mirage: The peril of improving laboratory markers in meningococcal-induced cardiac tamponade
(Elsevier, 2026) Özyüksel, Arda
In this issue of JACC: Case Reports, Pagotan et al describe a compelling case of immune-mediated meningococcal pericarditis progressing to car diac tamponade despite apparent microbiological resolution and improving laboratory parameters.
Bilateral circumferential ınternal jugular vein decompression for atlanto-styloid compression syndrome: Report of 14 cases
(Lippincott Williams and Wilkins Ltd., 2026) Aghayev, Kamran; Demir, Hüseyin; Özdöl, Çağatay; Comella, Zachary; Vrionis, Frank D.
BACKGROUND AND OBJECTIVES: External compression of the internal jugular vein (IJV) between the transverse process of the atlas (C1TP) and the styloid process is an emerging nosological entity. Various surgical treatment methods have been used, yet there is no consensus regarding the optimal surgical strategy. In this article, we present a novel surgical technique and clinical outcomes of 14 patients treated with circumferential decompression. METHODS: A retrospective chart review of 14 patients (9 men, 5 women) diagnosed with IJV stenosis between the C1TP and the styloid process was performed. The surgical technique included styloidectomy, C1 transversectomy, myectomy of the styloid muscles and posterior belly of the digastric muscle, transection of the occipital artery, and wide opening of the carotid sheath around the IJV. All but 1 patient underwent bilateral decompression. Clinical evaluation included self-reported improvement on a subjective improvement scale. Radiological assessment was performed by comparison of pre-and postoperative IJV cross-sectional area (CSA) at the point of maximal stenosis. A paired t-test was used for statistical analysis. RESULTS: The mean age was 44.7 yr (25-60), and the mean follow-up duration was 488 days (range 329-761). The right mean IJV CSA increased from 18.3 to 46.1 mm 2 (P = .0058). The left mean IJV CSA increased from 10.1 to 28.8 mm 2 (P = .000076). The IJVs shifted and expanded posteriorly toward the C1TP resection cavities in all cases. Nine patients reported significant and 5 moderate improvements. One patient developed transient trapezius muscle weakness because of XI nerve palsy. CONCLUSION: Bilateral circumferential IJV decompression is a feasible and safe technique and provides maximal IJV decompression.
Robotic eTEP-TAR abdominal wall reconstruction for complex post liver transplant incisional hernia with concomitant inguinal hernia repair: A video vignette
(Springer Nature Link, 2026) Bayrakçeken, Serra; Benlice, Çigdem; Aghayeva, Afag; Kudsi, Omar Yusef; Baca, Bilgi
Introduction Complex incisional hernias after major upper abdominal surgery are technically challenging because of altered anatomical planes, multiple fascial defects, and expected adhesions. Robotic enhanced-view totally extraperitoneal repair with transversus abdominis release may provide a minimally invasive option for selected patients by enabling retromuscular dissection, fascial closure, and wide extraperitoneal mesh reinforcement while limiting intraperitoneal manipulation. Case presentation This video vignette presents an 84-year-old man with multiple incisional hernia defects along a previous Mercedes incision after liver transplantation and a concomitant left direct inguinal hernia. Preoperative imaging demon strated a wide subxiphoid abdominal wall defect and a fat-containing left inguinal hernia. Surgical technique A robotic eTEP-TAR approach was performed. Bilateral retromuscular dissection was completed, the inguinal and incisional hernia contents were reduced, and bilateral transversus abdominis release was performed to facilitate medial fascial advancement and lateral extension of the working space. The fascial and peritoneal defects were closed intra corporeally, and wide mesh reinforcement was achieved using a 30 × 30 cm polypropylene mesh, with additional meshes placed for the inguinal and lower quadrant defects. The postoperative course was uneventful, and the patient was discharged on postoperative day 2. At postoperative day 7 follow-up, he had no complaints, and the wounds were clean. Conclusion This case demonstrates the feasibility of robotic eTEP-TAR abdominal wall reconstruction with concomitant inguinal hernia repair in a selected post-transplant patient with complex abdominal wall defects.
Multicenter machine learning model using clinical and radiomic features for prediction of postoperative residual status in meningioma
(American Association of Neurological Surgeons, 2026) Şanlıer, Nafiye; Yüce, Murat; Sulaimanov, Umid; Ismayilova, Gular; Hüryol, Çağın; Bozkurt, Hüseyin; Öztürk, Öykü; Öztürk, Fikret; Demir, Hüseyin; Başkaya, Mustafa K.
OBJECTIVE Gross-total resection is the primary surgical objective in meningioma management; however, predicting re sectability preoperatively remains challenging, particularly for meningiomas located in the skull base that exhibit complex anatomical relationships. There is a lack of validated reproducible models that integrate known anatomical factors for surgery; similarly, the value of radiomics as a stand-alone predictor is still unclear. The aim of this study was to develop a machine learning model that combines clinical and radiomic features to estimate early postoperative residual menin gioma. METHODS This retrospective multicenter study included 369 patients who underwent meningioma resection from 2020 to 2024 and had available preoperative contrast-enhanced T1-weighted MRI. Patient data from 3 centers (n = 307) were used to develop the model using leave-one-center-out cross-validation, and an independent cohort (n = 62) was used for external validation. Radiomic features were derived from manually segmented meningiomas, filtered for reproducibility, and integrated with 6 predefined clinical variables. The clinical-only, radiomics-only, and combined models were trained using 4 machine learning classifiers. Model performance was assessed through cross-validation, independent external validation, and receiver operating characteristic analysis. Formal incremental benefit analyses were performed on the common overlap external subset, with predictions available for all compared models. RESULTS Residual meningioma occurred in 23.5% of patients in the development cohort and 14.5% in the external cohort. Lesion location and venous sinus involvement were significantly associated with residual status. Following the feature selection, 2 stable radiomic texture features were retained. In external validation, the combined radiomics-clinical k-nearest neighbors model achieved the highest area under the curve (0.821), with sensitivity of 0.889, specificity of 0.706, and accuracy of 0.733. Clinical variables provided most of the predictive value, whereas radiomic features provided only limited incremental value when added to the clinical model. Decision curve analysis revealed net benefit for the combined model within a narrow range of low thresholds. CONCLUSIONS In this multicenter study, which included external validation, clinical variables provided most of the predictive value for postoperative residual meningioma. Radiomic features alone showed limited discrimination and only modest added value beyond clinical predictors. These combined models could serve as decision-support tools for preoperative risk assessment in meningioma surgery but are not yet suitable for routine stand-alone clinical use.
Is d-dimer associated with disease severity and contralateral slip risk in slipped capital femoral epiphysis?
(Wolters Kluwer, 2026) Kürk, Muhammed Bilal; Albayrak, Kutalmış; Aydın, Abdurrahman; Kayış, Görkem; Akpınar, Evren
Background: To evaluate D-dimer levels in patients with slipped capital femoral epiphysis (SCFE), to investigate their associa tion with disease severity and the development of contralateral slip, and to assess their contribution to existing predictive models. Methods: In this single-center retrospective cohort study, 25 patients with unilateral SCFE diagnosed between January 2020 and April 2024 were included. The control group con sisted of age- and sex-matched obese individuals and healthy subjects with normal body mass index (BMI). Clinical varia bles (age, sex, BMI, stability according to the Loder classi fication, and chronicity); laboratory parameters [complete blood count, neutrophil-to-lymphocyte ratio (NLR), in flammatory markers including C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), and coagulation pa rameters including prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, and D-dimer]; and radiographic measurements [Southwick angle, interhip angle difference, posterior sloping angle (PSA), and modified Oxford bone score (MOBS)] were analyzed. Subgroup analyses based on stability and chronicity were performed, and correlations between D-dimer levels and clinical, laboratory, and radio graphic parameters were assessed. Multivariable logistic re gression models were constructed to predict contralateral slip, and model performance was evaluated using receiver operating characteristic (ROC) curve analysis. Results: D-dimer levels were significantly higher in the SCFE group compared with both obese and healthy control groups (P < 0.001). D-dimer showed positive correlations with CRP and NLR and negative correlations with the MOBS and the interhip Southwick angle difference. Higher D-dimer levels were ob served in unstable and acute-on-chronic cases (P < 0.001). During a mean follow-up of 24 months, patients who developed contralateral slip had significantly higher D-dimer levels (P = 0.002). The addition of Southwick angle difference to a baseline model including age and MOBS increased the AUC from 0.73 to 0.80, while further inclusion of D-dimer improved the AUC to 0.87. However, the increase in AUC after addition of D-dimer was not statistically significant according to the paired DeLong test (P = 0.18). Conclusion: D-dimer levels are associated with disease severity and the risk of contralateral slip in SCFE. Incorporation of D-dimer into established clinical and radiographic parameters improved predictive model performance. These findings support the role of inflammatory and microvascular processes in the pathogenesis of SCFE and suggest that D-dimer may serve as a useful adjunct biomarker for risk stratification.
Postoperative pain after vNOTES versus laparoscopic hysterectomy: A procedure-specific comparative study
(Turkish Society of Obstetrics and Gynecology, 2026) Şahin, Turan; Şahin, Eda Adeviye; Perkyürek, Buse Sahra; Güzeltaş, Gökan; Tekin, Arzu Bilge; Gök, Koray; Şahin, Hanifi
Objective: Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is associated with lower postoperative pain, reduced analgesic requirements, and faster early postoperative recovery compared with laparoscopy in patients undergoing hysterectomy for benign indications. To compare postoperative pain and early recovery outcomes between vNOTES and conventional laparoscopy in patients undergoing hysterectomy for benign gynecologic indications. Materials and Methods: This single-center retrospective cohort study included 192 patients who underwent hysterectomy between March 2021 and September 2025. Patients were grouped according to surgical approach (vNOTES vs. laparoscopy). Postoperative pain was assessed using the visual analog scale at 6 and 24 hours. Primary outcomes were pain intensity and the requirement for additional analgesia. Secondary outcomes included operative time, change in hemoglobin, time to first flatus, and length of hospital stay. Multivariable logistic regression analysis was performed to identify predictors of analgesic requirement. Results: Of 192 patients, 75 (39.1%) underwent laparoscopy and 117 (60.9%) underwent vNOTES. Baseline characteristics were similar between groups. The vNOTES group had significantly lower pain scores at 6 and 24 hours (p=0.001) and a reduced need for additional analgesia (23.9% vs. 60.0%, p=0.001). Operative time was shorter and recovery outcomes, including time to first flatus and length of hospital stay, were significantly improved in the vNOTES group (p=0.001). Surgical approach, uterine weight, and operative time were independent predictors of analgesic requirement. Conclusion: In this retrospective cohort study, vNOTES was associated with lower postoperative pain scores, reduced analgesic requirement, and earlier recovery than conventional laparoscopy. These findings should be confirmed in prospective randomized studies.
Integrated genome-wide DNA methylation and transcriptomic analysis prioritizes EPHA5 as a candidate non-invasive epigenetic biomarker for oral squamous cell carcinoma
(Frontiers Media S. A., 2026) Demokan, Semra; Özemek, Begüm; Turna, Seval; Cömert, Sevde; Şen, Cömert; Avcı, Kağan; Özkan, Ahmet; Şen, Sena; Poda, Mehveş; Ulusan, Murat; Sezerman, Uğur; Ak, Gülsüm; Alatlı, Fatma Canan; Dalay, Nejat
Purpose: Oral squamous cell carcinoma (OSCC) remains a major clinical challenge because of delayed diagnosis and the lack of validated non-invasive biomarkers for OSCC detection. Epigenetic alterations during oral carcinogenesis represent promising biomarker candidates. This study aimed to prioritize clinically relevant epigenetic biomarkers and validate EPHA5 using an integrated genome-wide DNA methylation and transcriptomic approach. Experimental Design: Genome-wide DNA methylation and transcriptomic profiling were performed to identify epigenetically deregulated genes in OSCC. Candidate genes were prioritized by integrating DNA methylation, transcriptomic data and biological relevance. EPHA5 was subsequently selected for validation and evaluated by quantitative methylation-specific PCR (QMSP) and quantitative real-time PCR (QRT-PCR) in tissue, saliva and serum samples from independent cohorts comprising patients with OSCC, oral premalignant lesions (OPML) and healthy controls. Results: Genome-wide analysis identified 661 upregulated and 577 downregulated genes together with 2,431 differentially methylated regions corresponding to 1,776 genes. Integrated analysis generated a panel of 51 candidate genes, from which EPHA5 was prioritized using integrated DNA methylation, gene expression, pathway enrichment and biological relevance. EPHA5 promoter hypermethylation was detected in 66.7% of OSCC tumors, whereas concurrent promoter hypermethylation and reduced expression were observed in 28.6% of tumors. Methylation was also detected in 54.5% of OPML lesions and in the saliva of 47.6% of OSCC patients but was rarely detected in healthy controls. Tumor EPHA5 methylation significantly discriminated OSCC from healthy controls (AUC = 0.780, p = 0.004; sensitivity, 71.4%; specificity, 75%). Salivary EPHA5 methylation also significantly discriminated OSCC from healthy controls (AUC = 0.717, p = 0.025; sensitivity, 52.4%; specificity, 87.5%), whereas serum methylation showed no significant diagnostic utility (AUC = 0.571, p = 0.462). Discrimination between OSCC and OPML was limited and did not reach statistical significance (tumor AUC = 0.662, p = 0.068; salivary AUC = 0.600, p = 0.264). Conclusions: Frequent tumor hypermethylation together with detectable salivary methylation supports further evaluation of EPHA5 as a candidate non-invasive epigenetic biomarker for OSCC. However, its moderate diagnostic performance, limited discrimination between OSCC and OPML, and lack of external validation indicate that larger prospective studies and evaluation within multimarker methylation panels are required before clinical implementation.
Experimental sciatic nerve neuropathy caused by diclofenac sodium in rats
(Kare Publishing, 2026) Aykut, Ali Maksut; Kaya, Mustafa Emrah; Oral, Şükrü; Serarslan, Yurdal; Aras, Mustafa; Yılmaz, Atilla; Özgür, Tümay; Doğan, Serdar
OBJECTIVE: Our aim in this study is to investigate the total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) values of diclofenac sodium, which is a non-steroidal anti-inflammatory analgesic, after sciatic nerve injury, to examine the histopathological changes in the sciatic nerve, and to examine the results and enable important changes in treatment. It is one of the rare studies conducted histopathologically on post-injection sciatic nerve damage of diclofenac sodium, and the parameters of our biochemical approach have not been evaluated before in the literature. METHODS: study was divided into 5 main groups as control, sham, trauma, isotonic fluid, and diclofenac sodium. Sham, trauma, isotonic fluid, and diclofenac sodium groups were divided into four subgroups as early stage (day 1, day 3) and late stage (day 7 and day 14). Subjects in each group were evaluated daily by neurological examination according to the Tarlov scale. In all groups except the control group, the sciatic nerve was exposed through appropriate surgical procedures. TAS, TOS, and OSI were run on blood samples biochemically. Nerve tissue samples were evaluated histopathologically and immunohistochemically. RESULTS: There was a significant difference in pairwise comparison of the groups in terms of CASPASE-3 values. A statis tically significant difference was found between the groups in terms of myelin thickness and axon diameter. A statistically significant difference was found between the groups in terms of nerve diameter values. CONCLUSION: Our study demonstrates that intramuscular injections of diclofenac sodium have potential harmful ef fects. We recommend that alternative methods of using diclofenac sodium intramuscularly be preferred whenever possi ble due to the potential complications associated with this drug, that healthcare professionals receive necessary training on intramuscular administration, that the procedures be performed more carefully, and that patients be informed about these complications.
Anatomical location is associated with clinicopathological features and long-term oncological outcomes in mucinous colorectal adenocarcinoma: A population-based analysis of 40,698 patients from the SEER database
(MDPI Publishing, 2026) Kutlu, Burak; Benlice, Çiğdem
Background: Mucinous adenocarcinoma (MAC) of the colorectum is a biologically distinct histological subtype whose prognostic significance may vary substantially according to primary tumor location. The impact of anatomical site on clinicopathological characteristics and long-term survival in MAC remains incompletely characterized. This study aimed to evaluate the influence of tumor location on oncological outcomes in patients with mucinous colorectal cancer using a large population-based dataset. Methods: Patients diagnosed with mucinous colorectal adenocarcinoma between 2000 and 2023 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Operated patients were stratified by anatomical location into three groups: right colon (cecum, ascending colon, hepatic flexure, transverse colon), left colon (splenic flexure, descending colon, sigmoid colon, rectosigmoid junction), and rectum. The primary endpoints were overall survival (OS) and cancer-specific survival (CSS). Survival analyses were performed using the Kaplan–Meier method with log-rank testing. Multivariable Cox proportional hazards regression was used to assess the independent association of tumor location with survival outcomes, adjusting for age at diagnosis, year of diagnosis, sex, AJCC (American Joint Committee on Cancer) stage, tumor grade, receipt of radiotherapy and chemotherapy. Temporal trends in survival were evaluated across four consecutive diagnostic periods: 2000–2005, 2006–2011, 2012–2017, and 2018–2023. Results: A total of 40,698 patients with mucinous colorectal cancer were identified, of whom 40,174 underwent cancer-directed surgery (right colon n = 25,317; left colon n = 10,408; rectum n = 4449). The right colon was the predominant site of disease (62.9%). Median age was highest in the right colon group (74.0 years) and lowest in the rectum (65.0 years), while female sex predominated in right-sided tumors (55.7%) and male sex in rectal tumors (61.1%). Chemotherapy and radiotherapy utilization were markedly higher in the rectal group (68.6% and 64.5%, respectively) compared with the right colon (28.8% and 1.1%). Median OS was equivalent in the right and left colon groups (87.0 months each) but declined to 80.0 months in the rectal group. All pairwise CSS comparisons were statistically significant (all p < 0.001). On multivariable analysis, using the right colon as reference, the adjusted hazard ratios for CSS were 1.33 (95% CI: 1.28–1.39) for the left colon and 1.45 (95% CI: 1.34–1.57) for the rectum (both p < 0.001). Despite receiving the highest rates of multimodal therapy, rectal MAC demonstrated the worst long-term CSS across all anatomical groups. Temporal analyses revealed consistent CSS improvements in right-sided and left-sided MAC over the study period, whereas rectal MAC showed a non-linear trajectory with a plateau in the most recent diagnostic cohort (2018–2023). Conclusions: Mucinous colorectal adenocarcinoma demonstrates substantial biological and prognostic heterogeneity according to anatomical tumor location. Right-sided MAC was the most prevalent subtype and exhibited superior cancer-specific survival despite older patient age and lower treatment intensity. Rectal MAC demonstrated the worst long-term outcomes despite high utilization of multimodal neoadjuvant therapy, consistent with the established reduced responsiveness of mucinous tumors to conventional chemoradiotherapy. These findings underscore the necessity of incorporating anatomical location and tumor biology into individualized risk stratification and therapeutic planning for patients with mucinous colorectal cancer.
Outcomes of first 60 vaginal myomectomies by one gyn surgeon with 20 years of extensive vaginal surgical expertise
(BioMed Central, 2026) Şahin, Eda Adeviye; Şahin, Turan; Ağlamış, Savaş Özgür; Tekin, Arzu Bilge; Şahin, Hanifi
Introduction This retrospective single-center study based on prospectively collected data aimed to evaluate changes in operative performance during the initial experience with vaginal myomectomy. Methods Sixty consecutive patients who underwent VM between January 2021 and December 2023 were included. Demographic features, FIGO-classified myoma characteristics, operative variables, and postoperative outcomes were recorded prospectively. To assess the LC, patients were divided chronologically into four groups of 15 cases. The primary objective was to evaluate changes in operative performance across consecutive cases. Operative time, estimated blood loss, hematocrit decrease, and hospitalization duration were used as measurable indicators of surgical progression, while the occurrence of major complications was assessed as a safety outcome. Groups were compared in terms of preoperative characteristics, intraoperative parameters, and postoperative outcomes. Results The mean age and BMI of the patients were 38.1 years and 28.2 kg/m², respectively. Myoma number, diameter, and FIGO-based localization were similar across all groups (p > 0.05). No major intraoperative or postoperative complications occurred. Hematocrit drop and estimated blood loss were significantly higher in the first 15 cases compared to subsequent groups (p = 0.033 and p = 0.005). Operative time significantly decreased after the first 30 cases (p = 0.001), while length of hospital stay significantly shortened after the first 15 cases (p = 0.001). Transfusion rates did not differ between groups (p = 0.923). Conclusion The findings suggest that improvements in bleeding parameters and hospitalization duration became apparent after approximately 15 procedures, whereas operative efficiency improved and appeared to stabilize after approximately 30–34 procedures. These observations should be interpreted within the context of the initial experience of an experienced vaginal surgeon rather than as universally applicable thresholds.
Defining sagittal knee phenotypes via monopedal static anterior tibial translation. Part 2: The assessment-led personalization (ALP) system for indication and correction target planning in slope-reducing osteotomy
(Wiley, 2026) Kayaalp, Mahmut Enes; Kahraman, Hamit Çağlayan; Erden, Tunay; Lutter, Christoph; Scheffler, Sven; Taşer, Ömer; Becker, Roland; Hirschmann, Michael T.; Dejour, David H.
Current decision‐making for slope‐reducing osteotomy (SRO) often relies on isolated posterior tibial slope (PTS) thresholds, potentially misidentifying patients with acquired soft‐tissue decompensation or possibly overtreating those with an asymptomatic, inherently hyperlax baseline. Furthermore, rigid point‐based scoring systems oversimplify the synergistic biomechanics of the anterior cruciate ligament‐deficient knee. Building on the foundational ‘Set‐Point’ theory established in Part 1, this paper introduces the assessment‐led personalization (ALP) system. This unified clinical algo rithm integrates the normalized percentage of absolute static anterior tibial translation (sATT%) and its side‐to‐side difference (ΔsATT%) with PTS la terality, generalized hyperlaxity, and injury chronicity. By mathematically calibrating raw translation data to isolate true soft‐tissue decompensation from underlying osseous asymmetry, the ALP system provides a proactive, joint‐preserving framework to identify high‐risk phenotypes likely to fail isolated soft‐tissue reconstruction and precisely refines the indications for SRO. Level of Evidence: Level V.
Defining sagittal knee phenotypes via monopedal static anterior tibial translation. Part 1: Translating weight bearing sagittal position into clinical risk profiles
(Wiley, 2026) Kayaalp, Mahmut Enes; Kahraman, Hamit Çağlayan; Erden, Tunay; Lutter, Christoph; Scheffler, Sven; Taşer, Ömer; Becker, Roland; Hirschmann, Michael T.; Dejour, David H.
Static anterior tibial translation (sATT) is a reproducible monopodal weight‐bearing radiographic parameter that reflects the resting sagittal position of the tibiofemoral joint. Distinct from manual laxity tests that quantify passive displacement limits, sATT captures the functional equilibrium of the tibia under physiological load, representing the cumulative interplay of bony morphology, neuromuscular control, me niscal containment and time‐dependent adaptations. Current literature frequently conflates passive laxity with weight‐bearing sagittal position, leading to an incomplete understanding of why isolated soft‐tissue re constructions fail in biomechanically hostile environments. Elevated sATT manifests in three clinically distinct sagittal phenotypes with specific pathomechanisms: osseous anteriorization primarily related to increased posterior tibial slope and loss of the anterior cruciate liga ment; acquired soft‐tissue anteriorization resulting from sagittal decompensation due to chronic injury and secondary stabilizer, partic ularly meniscal deficiency; and inherent soft‐tissue anteriorization characteristic of generalized hyperlaxity. This paper, Part 1 of a two‐part series, establishes the biomechanical ‘set‐point’ theory, highlights the necessity of strict monopedal imaging to unmask instability and defines how distinct sagittal phenotypes may converge, creating cumulative or synergistic risk patterns that increase the mechanical burden on the central pivot. Level of Evidence: Level V.
Can the ovary be preserved? Trajectory of anti-müllerian hormone after ovarian detorsion: A retrospective cohort study
(IMR Press, 2026) Şahin, Turan; Şahin, Eda Adeviye; Perkyürek, Şahin; Şahin, Hanifi
Background: This study aimed to evaluate the longitudinal trajectory of ovarian reserve by measuring serum anti-Müllerian hormone (AMH) levels in adult patients who underwent surgical detorsion for ovarian torsion, and to investigate the impact of symptom duration and selected clinical factors on postoperative AMH recovery. Methods: This retrospective cohort study included patients who underwent surgical detorsion for ovarian torsion and had serum AMH measurements available preoperatively and at 3 and 6 months postoperatively. Patients whounderwentoophorectomy orhadincompletefollow-up datawereexcluded. Demographiccharacteristics,symptomduration, torsion laterality, surgical approach, presence of polycystic ovary syndrome (PCOS), and surgical procedure (detorsion alone or detorsion with cystectomy) were recorded. Changes in AMH over time were analyzed using the Friedman test with pairwise Wilcoxon signed-rank comparisons. Subgroup differences were performed using the Mann-Whitney U or Fisher’s exact test. Results: A total of 34 patients were included in this study. Median AMH levels rose from 3.00 ng/mL (interquartile range [IQR]: 2.10–5.00) preoperatively to 4.00 ng/mL(IQR:2.60–4.88) at 3 monthsand5.00ng/mL(IQR:3.60–6.00)at6monthspostoperatively (overall p < 0.001). AMHlevels were significantly higher at both 3 and 6 months compared with preoperative values (p = 0.021 and p < 0.001, respectively), with a further increase observed between 3 and 6 months (p < 0.001). No significant differences in AMH recovery were observed based on PCOS status, surgical approach, surgical procedure, or torsion laterality. Conclusions: Ovarian reserve recovery after detorsion appears to be time-dependent, and longitudinal assessment of AMH provides a more informative evaluation than single postoperative measurements. Prolonged symptom duration is associated with reduced biochemical recovery of ovarian reserve, highlighting the importance of early diagnosis and prompt surgical intervention in ovarian torsion.
Prospective MRI-based comparison of graft maturation after ACL reconstruction using quadriceps versus hamstring tendon autograft
(SAGE Publications, 2026) Erden, Tunay; Ağır, Muzaffer; Kayaalp, M. Enes; Toker, Berkin; Taşer, Ömer
Background: Biological graft maturation after anterior cruciate ligament (ACL) reconstruction is a prolonged and heterogeneous process that may not directly correlate with clinical recovery. Magnetic resonance imaging (MRI)–based signal intensity ratio (SIR) is widely used as an indirect marker of graft remodeling and early maturation. However, comparative data regarding MRI-based graft maturation between quadriceps tendon (QT) and hamstring tendon (HT) autografts remain limited. Purpose: To compare graft maturation between all–soft tissue QT autografts and HT autografts using quantitative MRI-based SIR at 6 and 12 months after primary all-inside ACL reconstruction in athletes. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 76 athletes undergoing primary all-inside ACL reconstruction were prospectively enrolled. QT autografts were used in 39 patients and HT autografts in 37 patients. All patients followed a standardized postoperative rehabilitation protocol and underwent 3.0-T MRI evaluation at 6 and 12 months. Graft maturation was assessed using SIR measurements obtained from standardized regions of interest along the intra-articular graft, with the posterior cruciate ligament used as reference. Interob server reliability was evaluated using intraclass correlation coefficients (ICCs). Results: Baseline patient characteristics and associated surgical procedures did not differ between groups (all P . .05). At both 6 and 12 months postoperatively, the mean SIR values were similar between QT and HT autografts (P . .05). Within-group analysis showed a significant decrease in SIR values from 6 to 12 months in both groups (P\.05), indicating progressive graft maturation. The magnitude of SIR change did not differ between groups (P . .05). Interobserver reliability was excellent, with ICC(2,1) values of 0.98 at 6 months and 0.98 at 12 months. Conclusion: Quantitative MRI-based assessment using SIR demonstrated no significant difference in graft maturation between all–soft tissue QT and HT autografts at 6 and 12 months after primary all-inside ACL reconstruction. Both graft types showed comparable MRI-based maturation profiles during the early postoperative period, supporting QT autografts as a reliable alterna tive to HT autografts in athletic populations.
Durable patellar stability and high patient‐reported success at minimum 5‐year follow‐up after isolated suture tape MPFL reconstruction
(Wiley, 2026) Erden, Tunay; Ağır, Muzaffer; Kayaalp, Mahmut Enes; Toker, Berkin; Taşer, Ömer
Purpose: To evaluate the mid‐to‐ long‐term clinical and radiological out comes of isolated medial patellofemoral ligament reconstruction (MPFL‐R) using a high‐strength suture tape (HSST) construct in patients with recur rent patellar instability and no major osseous risk factors. Methods: Patients treated with isolated MPFL‐R using HSST and a single knotless femoral anchor between 2015 and 2021 were retrospectively re viewed. Inclusion criteria were recurrent lateral patellar instability (≥2 disloca tions or symptomatic subluxations) refractory to nonoperative treatment and a minimum postoperative follow‐up of 60 months. Patients requiring concomitant bony realignment or presenting with major anatomic risk factors (e.g., high grade trochlear dysplasia, severe patella alta, tibial tubercle–trochlear groove distance >20mm) were excluded. Clinical outcomes were assessed with the International Knee Documentation Committee (IKDC) subjective score, Kujala score and visual analogue scale (VAS) for pain. Patellar tilt was mea sured on axial magnetic resonance imaging (MRI). Postoperative instability events, complications and reoperations were recorded. Clinically meaningful improvements were assessed using minimal clinically important difference (MCID) and patient‐acceptable symptomatic state (PASS) thresholds. Kaplan Meier survival analysis was performed to estimate 5‐year survivorship free from redislocation (primary endpoint) and any postoperative instability (secondary endpoint). Postoperative instability was defined as clinically docu mented redislocation or symptomatic subluxation. Results: Eighty‐one patients (mean age 20.8 years; 31.4% female) were included. At a mean follow‐up of 79.4±14.3 months, one redislocation (1.2%) and two subluxations (2.5%) occurred. Five‐year survivorship free from redislocation was 98.8% (95% confidence interval [CI], 96.4%–100%), and survivorship free from any postoperative instability was 96.3% (95% CI, 92.2%–100%). All patient‐reported outcome measures improved signifi cantly from baseline to final follow‐up (all p<0.001). Ninety‐six percent of patients achieved the PASS threshold for IKDC (95% CI, 89.7%–98.7%), whereas PASS attainment for the Kujala score ranged from 74% to 86% depending on the applied cut‐off. Radiologically, patellar tilt improved substantially on MRI (p<0.001). Postoperative complications were infrequent and manageable, including five cases of arthrofibrosis (requiring manipulation under anaesthesia), one deep infection (treated with arthro scopic debridement) and three cases of implant‐related bursitis at the femoral fixation site. Conclusion: Isolated MPFL reconstruction using an HSST construct pro vided durable patellar stability and significant functional improvement at a minimum 5‐year follow‐up. This technique represents a reliable mid‐to long‐term option for isolated MPFL‐R in appropriately selected patients, especially when graft harvest morbidity and patellar bone preservation are concerns.
Hemodynamic and clinical effects of the levonorgestrel-releasing intrauterine system in symptomatic adenomyosis: A prospective doppler ultrasound study
(Elsevier, 2026) Şahin, Eda Adeviye; Şahin, Turan; Şahin, Hanifi; Küçüközkan, Tuncay
Objectifs : Évaluer les résultats cliniques, biologiques et les modifications hémodynamiques utérines après la pose d’un système intra-utérin au lévonorgestrel (SIU-LNG) chez des femmes atteintes d’adénomyose symptomatique associée à des saignements menstruels abondants. Méthodes : Cette étude prospective observationnelle a inclus des femmes préménopausées âgées de ≥30 ans présentant une adénomyose diagnostiquée par échographie transvaginale selon des critères échographiques reconnus compatibles avec les descripteurs ultérieurement formalisés dans le consensus MUSA révisé. Les pertes menstruelles évaluées par le Pictorial Blood Loss Assessment Chart (PBAC), la douleur évaluée par échelle visuelle analogique (EVA), les paramètres hématologiques, le volume utérin ainsi que les indices Doppler des artères utérines — indice de résistance (IR) et indice de pulsatilité (IP) — ont été évalués avant la pose du SIU-LNG et après 12 mois de suivi. Les comparaisons avant/après traitement ont été réalisées à l’aide de tests statistiques appariés. Résultats : Soixante-cinq patientes ont complété le suivi à 12 mois. Les scores PBAC ont significativement diminué (169,6 ± 49,6 vs 42,4 ± 20,6 ; p < 0,001), de même que les scores EVA (4,2 ± 1,8 vs 2,4 ± 0,8 ; p < 0,001). Les taux d’hémoglobine et d’hématocrite ont augmenté significativement (p < 0,001). Une réduction significative du volume utérin a été observée (161,3 ± 33,5 mL vs 123,0 ± 28,0 mL ; p < 0,001). Les valeurs d’IP des artères utérines n’ont pas été modifiées de manière significative, tandis que les valeurs d’IR ont augmenté significativement des deux côtés (p < 0,001). Aucune corrélation significative n’a été observée entre les variations de l’IR, la diminution du score PBAC et la réduction du volume utérin. Une aménorrhée a été observée chez 21,5 % des patientes à 12 mois. Aucun cas de maladie inflammatoire pelvienne ni de formation de kyste ovarien n’a été rapporté. Conclusions : Chez les femmes atteintes d’adénomyose symptomatique, le SIU-LNG est associé à une amélioration clinique et hématologique significative ainsi qu’à une réduction du volume utérin à 12 mois. L’augmentation observée de l’indice de résistance des artères utérines suggère que des modifications hémodynamiques pourraient participer à la réduction des saignements, en complément de la suppression endométriale, bien que cette relation demeure exploratoire. Le SIU-LNG apparaît ainsi comme une option thérapeutique efficace, bien tolérée et conservatrice de l’utérus dans la prise en charge de l’adénomyose symptomatique.
Myomectomy in pregnancy
(GLOWM, 2026) Tinelli, Andrea; Pecorella, Giovanni; Panese, Gaetano; Morciano, Andrea; Mykhailo, Medvediev V; Hatırnaz, Şafak; Aydın, Gerçek; Bıyık, İsmail; Stojković, Marta; Sparic, Radmila; Stark, Michael
Uterine fibroids, or leiomyomas, are the most common benign tumors of the uterus, arising from the smooth muscle (myometrium). They represent a major global health concern due to their impact on physical health, quality of life and economic wellbeing.1 During a woman's life cycle, uterine fibroids typically occur less frequently before puberty, are more common during the reproductive years and reduce in size after menopause.1 Histological studies indicate that uterine fibroids are characterized by three main features: increased sensitivity to sex steroid hormones, altered extracellular matrix deposition and enhanced proliferation of smooth muscle cells.2 Epidemiological research has identified several risk factors associated with leiomyoma growth, including age, ancestry, family history, reproductive factors, hormonal influences, hypertension and certain infections. Furthermore, specific dietary components may influence hormone-related diseases and the development of fibroids.

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