Lidocaine spray is a good option for reducing the pain experienced during insertion of an IUD. It reduces pain related to both tenaculum use and IUD insertion. Spray application is both easy and rapid. Paracervical lidocaine injection also reduces pain during IUD insertion, but has no effect on tenaculum-related pain; moreover, the injection itself is painful. Therefore, this option is not a plausible method for reducing pain during IUD insertion.

Objective:To identify anomalies of major retroperitoneal vascular structure (AMRVS) during oncological retroperitoneal surgery and to investigate the effects of these anomalies in surgical procedures.Materials and Methods:Two hundred twenty-nine patients who underwent systematic para-aortic and bilateral pelvic lymph node dissection up to the renal vein between September 2006 and December 2008 were included. Normal architecture and structural anomalies of inferior vena cava, abdominal aorta, renal arteries and veins, and common iliac artery and vein were studied.Results:The mean age of the patients was 54.2 years. Anomalies of major retroperitoneal vascular structure were present in 39 patients (17%). Anomalies of renal vessels were identified in 31 patients. Supernumerary renal arteries and veins observed in 11 patients (17%) were the most common renal vessel anomaly. Great vessel injury was present in 19 patients (8.3%). Vascular complication rate was 20.5% in patients with AMRVS. However, in 4 of 8 patients with vascular complication and AMRVS, the complication was not related with anomalous vascular structures. None of the complications was serious and were corrected surgically. There was no difference between patients with AMRVS and those without AMRVS regarding age, body mass index, the extent of upper abdominal dissemination of malignancy and presence of comorbidity for intraoperative bleeding. There was no difference in intraoperative hemorrhage and amount of transfused red blood cell units between the groups.Conclusion:Great vessel anomalies, discovered in 1 of 6 patients, were together with increased risk of vascular complications. The probability of presence of vascular anomalies should be taken into account during lymph node dissection.

SILS seems to be effective and safe for the treatment of benign adnexal masses. SILS appears to be advantageous regarding postoperative pain especially in the early period.

The purpose of this study is to analyse the effect of luteal-phase support on pregnancy rates in gonadotropin + intra-uterine insemination (Gn/IUI) and clomiphene citrate (CC) +IUI (CC/IUI) cycles in patients with unexplained infertility. Equal numbers of patients were recruited in two treatment arms (CC/IUI and Gn/IUI) (n = 100, n = 100, respectively). In each group, 50 patients received vaginal progesterone for 14 days (Crinone 8% vaginal gel, 90 mg per day) for luteal-phase support from the day after IUI and continued until menstruation or the 10th week of gestation if pregnant. There were 29 clinical pregnancies among 200 patients. Pregnancy rates were 12% in CC/IUI cycles, 10% in luteal-phase-supported CC/IUI cycles 16% in Gn/IUI cycles and 20% in luteal-phase-supported Gn/IUI cycles. Although pregnancy rates were higher in Gn/IUI cycles compared to CC/IUI cycles, luteal-phase support did not significantly affect the pregnancy rates in both groups. This study implies that luteal-phase support with progesterone has no pronounced beneficial effect on pregnancy rates in either CC/IUI or Gn/IUI cycles in patients with unexplained infertility.

Laparoscopy is one of the most frequently preferred surgical options in gynecological surgery and has advantages over laparotomy, including smaller surgical scars, faster recovery, less pain and earlier return of bowel functions. Generally, it is also accepted as safe and effective and patients tolerate it well. However, it is still an intra-abdominal procedure and has the similar potential risks of laparotomy, including injury of a vital structure, bleeding and infection. Besides the well-known risks of open surgery, laparoscopy also has its own unique risks related to abdominal access methods, pneumoperitoneum created to provide adequate operative space and the energy modalities used during the procedures. Bowel, bladder or major blood vessel injuries and passage of gas into the intravascular space may result from laparoscopic surgical technique. In addition, the risks of aspiration, respiratory dysfunction and cardiovascular dysfunction increase during laparoscopy. Large bowel injuries during laparoscopy are serious complications because 50% of bowel injuries and 60% of visceral injuries are undiagnosed at the time of primary surgery. A missed or delayed diagnosis increases the risk of bowel perforation and consequently sepsis and even death. In this paper, we aim to focus on large bowel injuries that happen during gynecological laparoscopy and review their diagnostic and management options.