Background: Uterine manipulators may decrease the incidence of complications associated with total laparoscopic hysterectomy (TLH), but contrary views exist regarding the use of uterine manipulators for TLH. There are insufficient data on the safety of TLH without a uterine manipulator in both benign and malignant cases. Data on the safety and outcomes of TLH performed without a uterine manipulator remain limited. While some studies have investigated this issue, direct comparisons between TLH with and without the use of a manipulator, particularly across both benign and malignant indications, are still relatively scarce. Objective: The purpose of this study was to analyze the results and complications of TLH either with (group B) or without a uterine manipulator (group A), which was performed for benign and malignant indications. Study Design: A retrospective comparative study was conducted to evaluate the results of TLH with and without the use of a uterine manipulator. Group A included 138 patients, and Group B included 1300 patients. Patient characteristics, surgical indications, uterine weight, blood loss/transfusion, intraoperative urinary/intestinal complications, postoperative complications, and the rate of conversion to laparotomy were analyzed. Results: Patient characteristics and uterine weights were similar. There was a significant decrease in hemoglobin in group B (1.37 versus 1.52, p < 0.05). There was no significant difference in the transfusion rates between the two groups. The intraoperative complication rates were 4.3% in group A and 2.8% in group B ( p > 0.05). After adjustment for malignant indication, group allocation was not significantly associated with intraoperative complications (OR = 0.57; 95% CI 0.23–1.42; p = 0.227). Rates of bladder, ureteral, and intestinal injuries were similar, although conversion to laparotomy was higher in group A (2.3% vs. 0%). Postoperative complication rates were also comparable between groups, and logistic regression showed no significant association after adjustment for malignancy (OR = 0.54; 95% CI 0.21–1.35; p = 0.184). Conclusion: Our findings indicate that TLH without a uterine manipulator can be safely performed in selected patients. However, as the procedure is technically more demanding and evidence remains limited, further multicenter prospective studies are needed to validate these results and guide appropriate patient selection. Trial registration: The study was conducted in accordance with the ethical standards set forth in the Declaration of Helsinki and approved by the Ethics Committee of Süleyman Demirel University (approval date: 08/06/2022, approval number: 12/165). Informed consent was obtained from the participants prior to participation.

Genital aesthetic and reconstructive surgery is increasingly central to survivorship focused gynecologic oncology. Radical operations and adjuvant radiotherapy can produce vulvar, vaginal, and perineal sequelae such as scarring, tissue loss, stenosis, and altered sensation that impair sexual function, continence, body image, and psychosocial well being. This chapter reviews surgical approaches (local and regional vulvar flaps; gracilis or rectus abdominis transfers in irradiated fields; selected split thickness skin grafts; vaginal reconstruction with the McIndoe technique, bowel segment interposition, or minimally invasive peritoneal vaginoplasty); psychosexual outcomes assessed with validated patient reported tools including the Female Sexual Function Index, Body Image Scale, and Hospital Anxiety and Depression Scale, alongside expectation management, pelvic floor rehabilitation, and psychosexual therapy; ethical, legal, and cultural frameworks grounded in autonomy, beneficence, nonmaleficence, and justice, with enhanced informed consent, precise classification of reconstructive versus elective procedures, institutional oversight, and culturally competent, trauma informed counseling; and timing with multidisciplinary planning that balances immediate and delayed reconstruction while preserving oncologic control. Future priorities include protocolized minimally invasive peritoneal techniques, regenerative volume restoration, routine integration of patient reported outcomes, and training and equity initiatives. Genital aesthetic reconstruction should be regarded as core survivorship care that restores dignity, function, and quality of life.

Background/Objectives: Bowel resection may be necessary during cytoreductive surgery (CS) in advanced epithelial ovarian cancer to achieve complete tumor removal. However, concerns about increased perioperative risks and unclear survival benefits have led to ongoing debate. This study aimed to evaluate the impact of bowel resection on perioperative mortality and overall survival (OS) in patients undergoing CS. Methods: We retrospectively reviewed 127 patients with FIGO stage IIB–IV epithelial ovarian cancer who underwent primary or interval CS between 2007 and 2021. Patients were stratified based on the performance of bowel resection. Clinical, surgical, and survival data were analyzed using Kaplan–Meier survival analysis and Cox proportional hazards modeling. Primary outcomes were 90-day mortality and OS. Results: Bowel resection was performed in 58 patients (46%) with more extensive disease and poorer ECOG performance scores. Although the resection group had increased perioperative risks (e.g., higher transfusion rates and ICU use), OS was similar between groups (log-rank p = 0.122). Multivariate analysis identified that increasing age (HR = 1.042, p = 0.005) was independently associated with poorer OS, whereas lymph node dissection (HR = 0.450, p = 0.003) and undergoing primary CS (HR = 0.540, p = 0.047) were associated with improved survival. Bowel resection was not independently associated with OS. Conclusions: Bowel resection does not adversely affect OS when optimal cytoreduction is achieved. Although it increases perioperative complexity, it can be safely incorporated into CS in selected patients. These findings support its use as part of an individualized surgical strategy for advanced ovarian cancer.

Aims: We aimed to determine the quality and readability levels of the texts that health readers access from websites related to HPV. Methods: 64 websites related to "human papilloma virus" were evaluated by using the Google search engine, in terms of readability and website information quality. The websites were divided into 6 groups according to their origins. Ateşman and BezirciYılmaz readability formulas were used for readability, DISCERN measurement tool and JAMA criteria were used for website information quality and reliability. The information quality and reliability of the websites were evaluated by an obstetrician and gynecologist and a gynecological oncology surgeon. Results: When the websites were evaluated according to the Ateşman readability formula, the readability score was found to be 57.2 and they were found to be moderately readable. According to the Bezirci-Yılmaz readability formula, the average readability score of all websites was found to be 12.8, that is, a readability at the undergraduate level was determined. When evaluated with the DISCERN tool, the average quality level of all websites was determined as "poor". It was seen that the texts prepared by the obstetrics and gynecology associations and the obstetricians and gynecologists were of higher quality than the other groups. It was observed that the quality of the texts was lower according to the gynecological oncology surgeon. Conclusion: It is noteworthy that the texts prepared by the obstetrics and gynecology associations received higher quality scores than the other groups. Website information resources prepared by obstetrics and gynecology associations should be increased and the readability and quality of other internet health information needs to be improved.

Background: Episiotomy rates remain high worldwide despite recommendations supporting restrictive use. Although antenatal pelvic floor muscle training (PFMT) and perineal massage have each demonstrated efficacy individually, their comparative effectiveness and their combined efficacy relative to other nonpharmacological interventions remain unclear. Methods: This randomized, assessor-blinded, controlled trial enrolled 431 low-risk pregnant women between 20–36 weeks of gestation. Participants were allocated to one of four study groups: PFMT alone (n = 132), PFMT + Swiss ball exercises (n = 58), PFMT + perineal massage (n = 88), and standard care (n = 153). The primary outcome was the episiotomy rate. Logistic regression analysis was performed to identify independent predictors of episiotomy. Results: The rates were 5.7% in the PFMT + perineal massage group, 58.6% in the PFMT + Swiss ball group, 68.6% in the control group, and 85.6% in the PFMT-alone group. PFMT + perineal massage significantly reduced the risk of episiotomy compared with both the control group and the PFMT-alone group (p < 0.001 for both). However, there was no significant difference in episiotomy rates between the PFMT + perineal massage group and the PFMT + Swiss ball group (p > 0.05). In contrast, PFMT alone was associated with a higher episiotomy rate than standard care (p = 0.001). Younger maternal age (adjusted odds ratio [aOR] = 0.89, 95% confidence interval [CI]: 0.85–0.93) and nulliparity (aOR = 25.4, 95% CI: 10.5–60.1) were strongly associated with episiotomy (p = 0.001). Conclusion: Combining antenatal PFMT with perineal massage dramatically lowered episiotomy rates. In contrast, isolated PFMT without perineal preparation may paradoxically increase episiotomy risk, potentially due to pelvic floor hypertonia. Antenatal education should therefore emphasize both pelvic floor strengthening and perineal distensibility. Clinical Trial Registration: This trial was retrospectively registered with ClinicalTrials.gov (registration link: https://clinicaltrials.gov/study/NCT07626333, registration number: NCT07626333).