Selma Oransay, MD
Dr. ORANSAY is 35 years experienced clinician in OB/ GYN. She worked in the main national maternity educational hospital of Turkey for 20 years than she moved to İstanbul and worked in private hospitals. Her published articles are mostly on topics of menopause and infertility. She is also experienced as a voluntary OB/GYN doctor in African healthcare program.
Robotic-assisted laparoscopy to manage severe diaphragmatic endometriosis
Diaphragmatic endometriosis is a rare extrapelvic form of endometriosis, with specific symptoms experienced by 30%, such as shoulder, chest, arm, and right upper quadrant pain. An early diagnosis is vital to prevent the disease progressively toward the thoracic cavity, causing catamenial hemothorax and/or pneumothorax. For this reason, when deep endometriosis is strongly suspected, it is worth evaluating the diaphragm intraoperatively using a minimally invasive approach. The published literature does not describe how to approach the diaphragm, which can be done laparoscopically…
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Performance of the 2021 AAGL endometriosis classification
The most common scoring system is the revised American Society for Reproductive Medicine (rASRM) staging system for endometriosis. However, this classification system was widely criticized for failing to correlate surgical complexity and to show patients' pain scales and fertility indexes. It also has a poor inter-observer agreement. To replace rASRM with an improved system, the American Association of Gynecologic Laparoscopists (AAGL) announced a new endometriosis classification in 2021. The primary objective was to correlate surgical complexity and usability, and the…
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A new pathogenetic hypothesis of endometriosis
Recent research has focused on perimenopausal women who experienced hematoperitoneum and lower abdominal pain, subsequently developing deep infiltrating endometriosis within a few months of the initial episode. Ultrasonographic evaluations revealed that a bleeding functional ovarian cyst was the primary cause of the hemoperitoneum. The link between spontaneous hematoperitoneum and the subsequent development of deep endometriosis is so strong that it can be reasonably considered causal. Based on this hypothesis, Dr. Vercellini et al. from the Department of Clinical Sciences and…
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Why we should prefer nerve-sparing surgery in deep endometriosis?
Despite its benign nature, deep endometriosis can mimic malignant processes and infiltrate multiple organs, blood vessels, ligaments, and nerves within the pelvis. When conservative medical management fails, the need for surgical excision of endometriotic lesions arises. The surgeons aim to complete the removal of lesions without harming urinary, bowel, and sexual functions. For this reason, they started using nerve-sparing techniques two decades ago to treat deep endometriosis. This technique involves identifying and preserving anatomic nerve fibers to minimize surgical denervation…
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Robot-assisted laparoscopy for deep infiltrating endometriosis of bowel
Deep infiltrating endometriosis is characterized by lesions larger than 5 mm that penetrate the peritoneum or invade the muscular layer of adjacent organs, affecting over 20% of women with endometriosis. Bowel involvement occurs in 5-12% of cases and may present with symptoms such as abdominal pain, hematochezia, and dyschezia. Medical treatment includes non-steroidal anti-inflammatory drugs, oral contraceptives, and progestins. Surgical removal of endometriotic lesions typically involves laparoscopic techniques such as discoid excision, rectal shaving, or segmental resections, chosen based on the extent…
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Superiority of hysterectomy over lesion excision in the treatment of rectovaginal endometriosis
Confirmative treatment of endometriosis includes excision or ablation of visible lesions while conserving the uterus and ovaries. On the contrary, the radical approach involves total hysterectomy and even bilateral oophorectomy to create a hypo-estrogen state, remove adenomyosis if it exists, and lead to amenorrhea. These radical processes carry both a high risk of postoperative complications and subsequent cardiovascular diseases and osteoporosis due to surgical menopause. Despite its potential disadvantages, the radical method aims to relieve the symptoms, remit the disease,…
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A literature review about postmenopausal endometriosis.
Typically, endometriosis disease brings relief to women after menopause, but some individuals continue to develop some endometriosis-related issues even after the cessation of menstruation. This enigmatic condition, called postmenopausal endometriosis, needs to be understood, and the disease must be diagnosed carefully. A new explanation for the occurrence of postmenopausal endometriosis is related to the dysregulation of aromatase activity due to genetic and epigenetic changes or genetic polymorphism. The absence of menstrual cycles poses diagnostic challenges and requires a unique approach…
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An often overlooked symptom: Sleep disorders in patients with endometriosis
Recent reports suggested that women with endometriosis have more frequent complaints of poor sleep, reduced quality of life, and higher pain scores when compared with healthy women. Patients experience fatigue and increased pain the day after insomnia. For this reason, knowledge about the severity and frequency of sleep disorders in women with endometriosis is important for gynecologists in clinical practice. Chaichian et al., from the Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran, set up an analytic-cross sectional…
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Retrograde Menstruation Theory Through Müllerian Anomalies
The pathogenesis of endometriosis is still under debate. Sampson also described this condition as "developmentally misplaced endometrial tissue" in 1925. To evaluate the theories of pathogenesis, Vercellini et al. from the Academic Center for Research on Adenomyosis and Endometriosis at the Department of Clinical Sciences of the University of Education, Milan, Italy, set up a literature exploration. To investigate the retrograde menstrual flow theory, the authors selected studies that compare the prevalence of endometriosis in obstructive and non-obstructive Müllarian anomalies.…
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Diagnosis and management of treatment in diaphragmatic endometriosis.
Diaphragmatic endometriosis is a rare extra-pelvic type of deep endometriosis with a prevalence of 0,19% to 4,75. In symptomatic women, the symptoms are characterized by non-specific chest pain, shoulder pain, right upper quadrant abdominal pain, and pneumothorax, whereas 75% of patients have a silent course that makes the diagnosis difficult. The clockwise peritoneal fluid current from the pelvis to the falciform and phrenic-colic ligaments explains why endometriotic lesions are seen 90% asymmetrically on the right side of the diaphragm. A previous spontaneous…
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Improving fertility in peritoneal endometriosis
Endometriosis is the most common gynecologic disease that affects 10-15% of women in their reproductive age. The causal relationship between endometriosis and infertility is not clear yet, but adhesions and anatomical distortions due to the progression of the disease are blamed. Although there are many classification systems for endometriosis, the most used one is the revised ASRM (rASRM) classification, based on visualizing the lesions during the operation. According to this classification system, minimal/mild or stage I/II endometriosis is defined as lesions…
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The need for fertility preservation in women with endometriosis
A variety of pathologies such as adhesions, inflammation, modified pelvic anatomy, and altered ovarian reserve are among the causes of infertility in women with endometriosis. Additionally, these patients experience suboptimal outcomes characterized by reduced pregnancy rates when they undergo assisted reproductive techniques. The molecular level involving dysregulation of steroids, oxidative stress, and angiogenesis within the follicular environment should be responsible for the cause of infertility in this disease. Moreover, removing ovarian endometriomas worsens the ovarian reserve and AMH levels. If the…
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Any link between endometriosis and neonatal uterine bleeding?
A Medline search using the keywords " neonatal uterine bleeding," " pathophysiology," and "premenarche" was made by Dr. Habiba et al. from the Department of Health Sciences, University of Leicester, Leicester, UK. A total of 2264 articles were collected, and the final twenty-one, after the exclusion criteria were used to compose the text recently published in Biomolecules. The authors aimed to focus on the evidence favoring and against the neonatal origin of perimenarchial endometriosis, they discussed the research in the…
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A concerning link between endometriosis and cardiovascular disease.
Endometriosis is a disease characterized by endometrial-like tissues outside the uterus, which causes inflammation, scarring, and adhesion formation. The pathologic process of forming those adhesions releases proinflammatory molecules, cytokines, and growth factors that may have systemic effects. Recent research, for example, mentioned an increased risk of atherosclerotic diseases in women with endometriosis. Unfortunately, early diagnosis and effective treatment of endometriosis remain limited in current practice. Under the leadership of Dr. Olivier Morel from the Division of Cardiovascular Medicine, Strasbourg University…
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Uterine innervation and its impact on endometriosis related pelvic pain.
Advancements in immunochemistry, fluorochromes, computer-associated anatomical dissection, and 3D reconstruction of uterine micro-innervation brought substantial progress in pelvic neuroanatomy. The complex uterine innervation and its interactions with uterine parts and layers are yet fully revealed. Austruc et al., from the Faculty of Medicine of Rennes University, France, reviewed the literature on the complexity of uterine innervation to deepen our understanding of female pelvic pain. The authors' final aim was to uncover valuable insights for enhancing pelvic nerve-sparing techniques in endometriosis…
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Key Aspects of Ureterolysis in deep endometriosis surgery
Deep endometriosis surgery needs talented surgeons to preserve and protect vital structures during the excision of endometriotic lesions. The technique for ureterolysis is essential to mitigate the risk of ureteral injuries and improve patient outcomes. Dr. Chatroux and Dr. Einarsson from the Department of Obstetrics and Gynecology of Harvard Medical School, Boston, USA, summarized the ureteral anatomy, identification, and optimal surgical practice of ureterolysis; and clarified the knowledge gaps about endometriosis surgery involving the ureter. After anatomical description and describing…
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The location of adenomyosis, and recurrent abortion
ESHRE defines repeated pregnancy loss (RPL) as the loss of pregnancies with two or more weeks of gestation. Adenomyosis is the presence of ectopic endometrium, in the myometrium. High-resolution transvaginal ultrasound and sonographic criteria can help to diagnose the disease clinically. However, no consensus has been reached on the classification of adenomyosis. The most likely reason why adenomyosis causes pregnancy complications is its location in the sub-endometrial layer of the myometrium. This affects the uterine functions, especially uterine peristalsis, which…
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Ultrasonographic findings and the clinical symptoms of pelvic endometriosis
Imaging techniques achieve the clinical diagnosis of endometriosis, which affects 10-15% of all women of reproductive age. Suspected patients with clinical history and symptoms need a systemic examination of the uterus, ovaries, adnexa, and peritoneal covering the rectouterine, retrocervical, and sigmoid regions. The efficacy of ultrasonographic examination has been shown in many studies. Transrectal and transvaginal ultrasonography are helpful and reliable tools for diagnosing endometriosis and mapping the nodules before laparoscopic surgery. Mostafavi et al., from the Department of Radiology…
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Visual representation of endometriosis pain
Endometriosis is accompanied by severe chronic pelvic pain that impacts quality of life, relationships, and work conditions. Studies aiming to improve pain are frequently encountered in the literature. Nonetheless, pain research is complex due to its subjective nature, and cannot be visualized. Various studies have focused on language tools such as metaphorical language to externalize the painful experience of women with endometriosis. Visual representation of pain means externalizing painful experiences not only captured by verbal accounts but also by color,…
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Women's willingness to donate menstrual blood for endometriosis research
The menstrual blood is 50-100 ml/per cycle, with 80% lost during the first three days. On the heaviest bleeding day, 2 to 8 ml may be collected from a cup worn for four hours. This fluid could be investigated by collecting viable immune and endometrial cells. The menstrual immune cells are similar to the circular immune cells in peripheral blood, with fewer T lymphocytes and more natural killer cells. The delay in diagnosing endometriosis is estimated to be 8 years.…
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