This study compared the surgical outcomes of total laparoscopic hysterectomy (TLH) and vaginal-assisted natural orifice transluminal endoscopic surgery (vNOTES) in patients with a history of gynecologic and obstetric surgery. This cross-sectional study included 100 women who underwent TLH (n = 50) and vNOTES hysterectomy (n = 50) for benign gynecological pathologies. The demographic features and surgical outcomes of all the patients were recorded retrospectively. Postoperative hematocrit values, Visual Analog Scale (VAS) scores (6-24th hour), uterine weights, operation time, hospital stay, postoperative analgesic application requirement, blood transfusion, vaginal cuff closure time, and intraoperative and postoperative complications were assessed. There were no differences in demographic features between the groups. The need for analgesic application was similar between groups (p = 0.590). Vaginal closure time was significantly shorter in the vNOTES group (p < 0.001). The surgery time and hospital stay were significantly shorter in the vNOTES group (p = 0.001 and p = 0.006, respectively), and there was no difference in complication rates between the groups (p = 0.992). The preoperative Htc values were similar in both groups (P = 0.980). There was no significant difference in the postoperative Htc values (p = 0.901). Postoperative 6th hour VAS score of the vNOTES group was significantly lower than that of the TLH group (p = 0.001). The vNOTES hysterectomy procedure has more advantages than TLH in terms of minimally invasive surgery, even in patients with a history of gynecologic and obstetric surgery.

Aim: In our study, we aimed to comprehensively evaluate the surgical parameters of patients who underwent total laparoscopic hysterectomy (TLH) and vaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy and their effects on the development of pelvic organ prolapse (POP) and sexual function one year later. Materials and Methods: This retrospective and comparative study involved a review of medical records for 42 patients who underwent total laparoscopic hysterectomy (TLH) for benign conditions and 42 patients who underwent hysterectomy using vaginal natural orifice transluminal endoscopic surgery (vNOTES) at our clinic between January 2023 and January 2024. Evaluations of preoperative and postoperative pelvic organ prolapse and sexual function were conducted, and the anatomical and functional outcomes of both surgical methods were compared. Results: In this study, there was no statistically significant difference between the groups in terms of age (p < 0.299), BMI (p < 0.819), parity (p < 0.615), surgical indications and menopausal status (p < 0.535) (p > 0.05). The vNOTES method was found to be significantly shorter than TLH in terms of surgical time (vNOTES: 58 min, TLH: 80 min, p < 0.001). However, there was no significant difference between the two methods in terms of preoperative and postoperative hematocrit values, hospital stay and FSFI scores (p > 0.05). Among the POP-Q parameters, a significant difference was observed only in the Aa parameter in favor of the vNOTES method (p < 0.003). Conclusions: In our study, the vNOTES method provided a shorter surgical time and better anterior vaginal support compared to TLH, but both methods offered similar results in terms of sexual function. More comprehensive studies are needed to clarify the long-term effects.

Background and Objectives: Epidural analgesia remains the gold standard for intrapartum pain relief; however, its influence on labor dynamics and neonatal outcomes in nulliparous women continues to be debated. This prospective cohort study aimed to investigate the effects of epidural analgesia on labor progression and neonatal outcomes among women experiencing spontaneous term labor. Materials and Methods: A total of 100 nulliparous women with singleton, cephalic pregnancies at 37–41 weeks of gestation were prospectively enrolled. Participants self-selected into either the epidural analgesia group (n = 50) or the no epidural analgesia group (n = 50) after standardized counseling on pain management options. Demographic data, labor characteristics, and neonatal outcomes, including the durations of the active and second stages of labor, the use of episiotomy or instrumental delivery, and the 1- and 5-min Apgar scores, were recorded and compared between groups. Group comparisons showed statistically significant differences when p values were below 0.05. Results: The active phase of labor was significantly longer in women receiving epidural analgesia compared with those without it, showing an approximately 60-min difference with a p value less than 0.001. The second stage was also modestly prolonged in the epidural group (p < 0.001). Although the episiotomy rate was higher among women with epidural analgesia, there were no significant differences in perineal tears or instrumental delivery. Neonatal outcomes were comparable between groups, with similar 1- and 5-min Apgar scores. Conclusions: Epidural analgesia modestly prolongs the active and second stages of labor in nulliparous women but does not adversely affect neonatal well-being. These findings support the continued use of epidural analgesia as a safe and effective option for labor pain management, providing substantial maternal comfort without compromising neonatal outcomes.

Background: Persistent infection with high-risk human papillomavirus (HPV) is the key driver of cervical carcinogenesis and post-treatment recurrence. Although excisional treatment effectively removes dysplastic tissue, it does not directly target viral persistence. While HPV vaccination is well established in primary prevention, its potential role as an adjuvant strategy in HPV-positive women, particularly with respect to viral clearance, remains incompletely defined. Methods: This retrospective cohort study included HPV-positive women with at least 12 months of follow-up who were managed at a tertiary gynecology clinic. Patients were stratified according to HPV vaccination status with the nonavalent vaccine (Gardasil 9) and excisional treatment status with loop electrosurgical excision procedure (LEEP). HPV clearance at 12 months was defined as the primary outcome, while histological outcomes were evaluated as secondary and independent endpoints. Analyses were performed in the overall cohort and stratified by LEEP status. Multivariable logistic regression was used to identify factors independently associated with HPV persistence, adjusting for baseline disease severity and clinical covariates. Results: A total of 935 HPV-positive women were included in the final analysis. Completion of the three-dose HPV vaccination schedule was associated with significantly higher HPV clearance rates at 12 months compared with no vaccination. This association was consistently observed in women who underwent LEEP as well as in those managed without excisional treatment. In multivariable analysis, HPV vaccination emerged as an independent protective factor against HPV persistence, whereas LEEP status itself was not independently associated with viral clearance after adjustment for baseline histological severity. Histological outcomes differed according to baseline disease severity and did not demonstrate a direct one-to-one relationship with HPV clearance. Conclusions: Adjuvant vaccination with the nonavalent HPV vaccine is independently associated with increased HPV clearance in HPV-positive women at 1-year follow-up, irrespective of excisional treatment status. HPV clearance and histological regression represent related but distinct biological processes and should be evaluated as independent outcomes. These findings support a broader role for HPV vaccination beyond primary prevention and suggest potential clinical benefit of vaccination as an adjunctive strategy in the management of HPV-positive women.

Objectives: To evaluate the prognostic value of systemic inflammatory response (SIR) parameters in predicting the recurrence of cervical intraepithelial neoplasia (CIN2+) in women undergoing a loop electrosurgical excision procedure (LEEP). Methods: This retrospective study included women aged ≥18 years who underwent an LEEP at a tertiary center between 2013 and 2023. Patients who were pregnant and those who had malignancies, immune disorders, or prior cervical surgery were excluded. The data collected included age, parity, cervical cytology, HPV DNA status, histology, LEEP specimen size, and preoperative blood count parameters. Follow-up was performed every six months using cytology, colposcopy, and histology to assess recurrence. The SIR markers evaluated included the neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), and lymphocyte count. Statistical analyses included ROC curves and Cox regression. Results: Of the 1068 patients included, 726 had follow-up data, and 32 (4.4%) experienced a recurrence after a mean interval of 24 ± 20 months. Recurrence-negative patients had higher median lymphocyte counts (2.40 vs. 2.15, p = 0.031) and LMRs (4.57 vs. 3.86, p = 0.011). The disease-free survival period was longer in patients with high lymphocyte counts, a low NLR and PLR, and a high LMR. However, the discriminatory power of these markers was limited. In the multivariate analysis, only a PLR > 118.4 remained independently associated with an increased recurrence risk (HR 3.06, p = 0.011). Due to the small number of cases of recurrences and the small amount of HPV DNA results, the findings should be interpreted with caution. Conclusions: Preoperative SIR markers such as the PLR, NLR, LMR, and lymphocyte count showed statistical associations with CIN2+ recurrence after an LEEP, but their clinical utility appears to be limited. Further prospective studies are needed to validate these findings.