Hacettepe Üniversitesi Açık Erişim Sistemi (HÜAES)
- HÜAES, Hacettepe Üniversitesi bünyesinde üretilen kitap, makale, tez, bildiri, rapor gibi tüm akademik kaynakları uluslararası standartlarda dijital ortamda depolar, etkisini artırmak için telif haklarına uygun olarak Açık Erişime sunar.
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Recent Submissions
Multivisceral Resection and Abdominal Wall Reconstruction for Recurrent Endometrial Cancer
(2025-01-04) Cengiz, Murat; Ege, Hasan Volkan; Akgor, Utku; Ozgul, Nejat; Gultekin, Murat; Basaran, Derman; Kadın Hastalıkları ve Doğum
Implementing High-Risk Human Papillomavirus Self-Sampling for Cervical Cancer Screening in Ghana: A Study (CarciSCAN) Protocol
(2025-03-10) Taumberger, Nadja; Friko, Ibrahim; Der, Vera Mwinbe-Ere; Ellis, Laura Burney; Shearer, Amy MacDonald; Bowden, Sarah J; Kyrgiou, Maria; Pan, Teresa L; Lessiak, Verena; Hofer, Neli; Rogatsch, Elisabeth; Nanda, Manurishi; Pfniss, Isabella; Joura, Elmar; Cinar, Alper; Kilic, Yalin; Gultekin, Murat; Kadın Hastalıkları ve Doğum
Background: The World Health Organization (WHO) aims to eliminate cervical cancer by 2030 through a global strategy, centred on high-risk Human papillomavirus (hrHPV)-based screening and treatment. Implementing these strategies in low-resource settings remains challenging, due to barriers associated with limited healthcare infrastructure and patient awareness. Self-sampling for hrHPV has shown higher acceptability and similar diagnostic accuracy compared to clinician-taken samples. This study proposes a protocol to evaluate the clinical efficacy of a cervical cancer screening program utilising hrHPV self-sampling in Ghana.Methods and Analysis: 1000 non-pregnant women aged 30-65 years will be invited to self-collect hrHPV samples. Those testing hrHPV positive will undergo visual inspection with acetic acid. Those diagnosed with high-grade squamous intraepithelial lesions will be offered ablation. In any case where there is a suspicion of invasion, or equivocal diagnosis, biopsies will be taken. Follow-up for women who are test positive for hrHPV and/or undergo treatment, will involve hrHPV self-sampling after 6 months. HrHPV-negative women will rescreen after 3 years. Biopsies will be taken where immediate treatment is not suitable, and women with confirmed or suspected invasive cervical carcinoma will be referred for surgical and/or oncological care. The primary outcome will be the proportion of women successfully screened, defined as the proportion of women with a valid HPV test result out of those invited to attend cervical screening. Secondary outcomes include screening uptake, disease detection rate, hrHPV genotype prevalence, treatment acceptance rate, successful treatment response, missed disease during treatment, number lost to follow-up, and disease recurrence.Discussion: In low-resource settings, hrHPV self-sampling offers an accessible method to increase screening uptake. This study will inform strategies for broader implementation of cervical cancer screening and contribute to achieving the WHO's goal of elimination by 2030.Trial Registration: Ethical approval for this study was obtained from the Kintampo Health Research Centre Institutional Ethics Committee (IEC), Bono East, Ghana, West Africa, on 24 May 2024 (IEC IRB Registration No. 0004854; Study ID: KHRCIEC/2024-03).
Prediction of Treatment Failure After Excisional Treatment of Cervical Precancer: A Systematic Review and Meta-analysis
(2025-10-01) Bomans, Leandro; Ramirez, Arianis Tatiana; Hillemanns, Peter; Gultekin, Murat; Arbyn, Marc; Kadın Hastalıkları ve Doğum
Objective: To evaluate the diagnostic accuracy and clinical utility of posttreatment tests to predict treatment failure after excisional treatment of cervical intraepithelial neoplasia grade 2 or worse (CIN 2+).
Data sources: Electronic databases (EMBASE, PubMed MEDLINE) were searched for studies published from January 1975 to August 2024 assessing the occurrence of treatment failure in women who underwent excisional treatment for histologically confirmed CIN 2+ lesion.
Methods of study selection: Previously published meta-analyses were extended and updated. A total of 1,802 studies were reviewed. Studies that assessed the diagnostic accuracy of the margin status, cytologic testing, combination of cytology and high-risk human papillomavirus (HPV), or combination of margin status and high-risk HPV compared with high-risk HPV testing were included. The primary outcome was treatment failure (residual or recurrent CIN 2+) and the absolute and relative diagnostic accuracy to predict this outcome. Studies with at least 18 months of follow-up were included.
Tabulation, integration, and results: Forty-six studies and 20,385 women were included in the analysis. Treatment failure occurred in 6.6% of patients. The pooled sensitivity and specificity of high-risk HPV testing were 86.8% and 80.5%, respectively. Cytology had a sensitivity of 70.8% and a specificity of 85.7%, pooled from 34 studies. Compared with high-risk HPV testing in the same studies, cytology was 6.5% more specific (95% CI, 1.024-1.108) but 21.3% less sensitive (95% CI, 0.702-0.882). Assessment of the margin status was 39.9% less sensitive (95% CI, 0.532-0.678) but similarly specific (95% CI, 0.970-1.069) to high-risk HPV testing in 29 studies, with a pooled sensitivity and specificity of 48.9% and 82.5%, respectively. Co-testing with cytology and high-risk HPV was similarly sensitive (95% CI, 0.992-1.061) but 10.5% less specific (95% CI, 0.850-0.944) compared with high-risk HPV testing in 16 studies, with a pooled sensitivity and specificity of 94.7% and 69.9%, respectively. The pooled sensitivity and specificity of co-testing with margin status and high-risk HPV were 96.9% and 55.7%, respectively, 6.6% more sensitive (95% CI, 1.021-1.114) but 26.7% less specific (95% CI, 0.637-0.844) than high-risk HPV testing in eight studies. Involved resection margins, abnormal cytology, and a positive high-risk HPV test result were associated with a failure risk of 16.1%, 29.0%, and 26.1%, respectively. Women with negative margins, normal cytology, and a negative high-risk HPV test result had a failure risk of 3.6%, 2.3%, and 0.9%, respectively. The risk of treatment failure was highest for women with involved margins and a positive high-risk HPV test result (45.3%) and lowest for women with negative margins and a negative high-risk HPV test result (0.3%). Abnormal cytology and a positive high-risk HPV test result increased the risk of treatment failure to 42%, whereas normal cytology and a negative high-risk HPV test result decreased the risk to 0.6%.
Conclusion: High-risk HPV testing is highly sensitive and specific to predict residual or recurrent CIN 2+ after excisional treatment. Cytologic testing and assessment of the margin status are slightly more and similarly specific, respectively, but both are significantly less sensitive. High-risk HPV testing can sufficiently inform the posttreatment management based on the posttest risk of treatment failure, unlike both cytology and assessment of the margin status. High-risk HPV testing alone performs similarly to co-testing with cytology or margin status. Posttreatment high-risk HPV testing is therefore an accurate predictor of treatment failure in women treated for CIN 2+.
Planning and performing simultaneous bariatric surgery and robotic hysterectomy in a super-obese patient with endometrial cancer
(2024-09-11) Ege, Hasan Volkan; Cengiz, Murat; Akkapulu, Nezih; Akgör, Utku; Gültekin, Murat; Ozgül, Nejat; Basaran, Derman; Kadın Hastalıkları ve Doğum
Endometrial cancer (EC) is the most common gynecological malignancy in developed
countries, and endometrial intraepithelial neoplasia (EIN) is the defined precancerous lesion.
Obesity is considered a risk factor for both EC and EIN. On the other hand, mortality is often
attributed to obesity-related conditions in patients with early-stage EC. Bariatric surgery has
been shown to improve oncological outcomes and obesity-related morbidity and mortality
in patients with EC. Therefore, combination surgery addressing both uterine disease and
obesity is a very recent point of interest. Here, we present a video article to demonstrate the
crucial surgical steps for a simultaneous robotic-assisted total laparoscopic hysterectomy
and sleeve gastrectomy in a patient with super obesity and EIN. A patient in her 40s with
a body mass index of 62.4 kg/m2
and a diagnosis of EIN was scheduled for combo surgery.
The operation started with sleeve gastrectomy in the reverse Trendelenburg position. The
da Vinci Xi Surgical System™ (Intuitive Surgical Inc., Sunnyvale, CA, USA) with left-side
docking was used for surgery. After the mobilization of the stomach, gastric resection
was performed using a stapler. Following sleeve gastrectomy, the patient was positioned
in the Trendelenburg position, and the robotic system was positioned for hysterectomy.
Hysterectomy and salpingectomy were performed. The excised stomach and hysterectomy
material were removed through the vagina. A frozen examination revealed EC below 2 cm
with superficial invasion, and bilateral oophorectomy was performed. The whole surgery
took approximately 4 hours. No postoperative complications occurred, and the patient was
discharged on the 3rd day.
Robotic-assisted neovaginal creation: stepwise approach to the Davydov technique in a patient with Mayer-Rokitansky-Küster-Hauser syndrome
(2025-05) Tuncer, Haticegul; Ege, Hasan Volkan; Akgor, Utku; Gültekin, Murat; Tuncer, Zafer Selcuk; Ozgul, Nejat; Basaran, Derman; Kadın Hastalıkları ve Doğum
Objective: To demonstrate the robotic-assisted Davydov technique for neovaginal creation in Mayer-Rokitansky-Küster-Hauser syndrome.
Design: Stepwise demonstration of the technique with narrated video.
Subjects: A 27-year-old patient has been diagnosed with Mayer-Rokitansky-Küster-Hauser syndrome since the age of 18 years. Three months ago, vaginal dilation was attempted at another medical center but was unsuccessful because of intolerance. Pelvic examination revealed a shallow vaginal dimple.
Exposure: After identification of the anatomical structures, the rectovaginal and vesicovaginal spaces were dissected, creating a space for the neovaginal canal and forming anterior and posterior peritoneal flaps. After complete dissection of the rectum from the posterior pelvic peritoneum, the vaginal remnant was bluntly dissected externally under guidance of a blunt-tipped curette handle and connected adequately to the introitus. Subsequently, the created anterior and posterior flaps were individually interrupted with sutures to form the neovaginal entrance. After the neovaginal entrance was established, the robot was used again to continuously suture the uterine remnants to create the anterior neovaginal wall. The uterine remnants, rectal serosa, and internal portions of the flaps were then joined together to form the neovaginal vault.
Main outcome measures: Demonstration of the steps for the robotic management of neovaginal creation in Mayer-Rokitansky-Küster-Hauser syndrome.
Results: The patient was discharged on postoperative day 1 with a soft mold in the vagina. On postoperative day 3, the soft mold was replaced with a medium-sized rigid mold. By postoperative day 6, the patient could insert a full-size rigid mold. The patient achieved full penetration and engaged in sexual activity within 1 month, with no postoperative complications observed. At the 8-month follow-up, the neovaginal cavity measured 13.4 cm in depth and 4.7 cm in diameter.
Conclusion: Creating a neovagina using the robotic-assisted Davydov technique in patients with Mayer-Rokitansky-Küster-Hauser syndrome is a safe, feasible, beneficial, and highly effective method. Although the superiority of robotic systems over laparoscopy has not yet been fully established through extensive publications, the advantages provided by high-image quality, magnification, and maneuverability are highlighted in this study. Robotic technology could be particularly beneficial for patients with obesity or those with complex pelvic anatomy because of prior surgeries.