Background/aim: Laparoscopic surgery has become the preferred minimally invasive technique for both diagnostic and therapeutic procedures in gynecology. Although it is associated with lower overall complication rates compared to open surgery, most serious complications occur during the initial step of abdominal entry. Therefore, developing faster and safer entry methods is critical to improving surgical outcomes. This study aimed to compare the surgical results of the Median Umbilical Ligament Lift-Up (MULU) technique routinely used in our clinic with the commonly preferred Veress needle (VN) entry technique. Materials and methods: This randomized, controlled, prospective study included 124 patients: 64 underwent abdominal entry with the MULU technique and 60 with the VN technique. Demographic data such as age, BMI, obstetric and surgical history, and menopausal status were recorded. Key perioperative outcomes, including abdominal entry time, number of attempts, insufflation failure, vascular or visceral injury, bleeding at the trocar site, infection, hematoma, and hernia were documented and analyzed. Results: The VN group had a significantly higher mean age (50.03 years) compared to the MULU group (45.42 years) (p<0.05). No significant differences were observed in height, weight, or BMI. The MULU technique demonstrated a significantly shorter mean entry time (71.5 vs. 146.3 seconds; p<0.05). Extraperitoneal insufflation occurred in 6.7% of VN cases and was absent in the MULU group (p=0.036). Gastric or intestinal injury occurred in 3.3% of VN patients, with none observed in the MULU group. Omental injury was seen only in the MULU group (3.1%). No significant differences were found in vascular injury, bleeding, or prior surgical history. Conclusions: The MULU technique, based on anatomical guidance via the median umbilical ligament, is a safe and effective method for abdominal entry. It offers faster access and may reduce the risk of major complications, making it a viable alternative to conventional techniques.

Objectives: Diagnostic hysteroscopy (DH) is a gold standard diagnostic imaging tool in gynecology. There is insufficient data in the literature regarding the reduction of pain felt during the DH and there is no study in the literature that examines the relationship between the measurement of uterine version or flexion angles and the pain felt during DH procedure. The aim of this study was to investigate the effects of uterine version or flexion angles on pain severity during DH and to identify predictive factors for severe pain experienced during the procedure. Material and methods: This prospective single-center cohort study included patients who were eligible for DH within medical indications. Exclusion criteria comprised menopausal status, congenital uterine anomalies, uterine fibroids larger than 2 cm detected on ultrasonography, suspected malignancy, or retroverted uterus. Before hysteroscopy, all patients underwent transperineal ultrasonography to measure uterine version and flexion angles. Patients were asked to rate their pain levels using a 0–10 numerical visual analog scale (VAS). Patients with VAS scores ≥ 6 were categorized into the severe pain group, while those with scores < 6 were classified into the moderate pain group. Results: The study comprised 98 women undergoing DH. Multivariate binary logistic regression analysis identified anteversion angle and nulliparity as significant predictors of severe pain during DH. The optimal cut-off value for predicting severe pain during DH was identified as 74.5°, providing a sensitivity of 66.7% and specificity of 69.0% [area under curve (AUC) = 0.722, p = 0.001]. Conclusions: This study demonstrates that a uterine anteversion angle narrower than 74.5° is associated with severe pain during DH. Keywords: diagnostic hysteroscopy pain severity transperineal ultrasonography uterine anteversion angle uterine flexion angle