Role of Oxidative Stress in Ovarian Tissue After CO2-pneumoperitoneum Application-induced I/R
Condition: Oophorectomy; Oxidative Stress; Ischemia Reperfusion Injury
MeSH terms: Pneumoperitoneum; Reperfusion Injury; Ischemia
Study type: Interventional

Summary: 
      Because of cellular changes in response to ischemia and a following period of reperfusion,
      damages to organs and different tissues occur. There are several ongoing studies to enlighten
      the pathophysiological processes underlying these damages inflicted by ischemia/reperfusion.

      Gases (CO2) with low water content are used in pneumoperitoneum, which is a procedure to
      inflate the abdominal cavity with an appropriate gas for laparoscopic operations. In the
      current literature, it was shown that due to a restricted blood flow during the gas
      insufflation, ischemia develops and with the reperfusion of the organ in deflation period,
      oxidative stress and inflammation increases, leading to ischemia/reperfusion-related organ
      and tissue damages.

      In the proposed study, biomarkers for ischemia/reperfusion-inflicted damage will be evaluated
      in a biochemical and histopathological perspective in biopsy samples of ovaries from a young
      patient group in which hysterectomy and bilateral salpingo-oophorectomy will be performed,
      laparoscopically.
    

Detailed description: 
      In the laparoscopic salpingo-oophorectomy, after the induction of anesthesia, an umbilical
      skin incision was performed. Pneumoperitoneum was established using dry, nonheated CO2
      insufflation through a Veress needle. A 10-mm trocar was inserted into the abdominal cavity
      through the umbilical incision for the laparoscope. Subsequently, three 5-mm ancillary
      trocars, 2 on the lower abdominal quadrants and 1 on the left upper quadrant, were introduced
      to the abdominal space under direct optic visualization. IAP was set at 14 mm Hg and
      maintained with a gas insufflator (Endoflator; Karl Storz Endoscopy, Tuttlingen,
      Germany)Immediately after the port placement, unilateral oophorectomy was performed, and
      ovarian biopsies were obtained. The operation continued with ligation and transection of the
      contralateral utero-ovarian ligament and the bilateral round ligaments. The contralateral
      infundibulopelvic ligament, which contains the main vascular supply for the contralateral
      ovary, remained intact. Subsequently, anterior and posterior leaflets of the broad ligament
      were identified and dissected, and the bladder was placed away from the lower uterine
      segment. The uterus removed from vaginal way after necessary steps. After desufflation, the
      cuff closure procedure was performed vaginally. At the end of the closure, pneumoperitoneum
      was reestablished, the remaining contralateral ovary was removed immediately, and biopsies
      were obtained for histologic analyses.
    

Intervention name(s): laparoscopic salpingo-oophorectomy; Laparoscopic bilateral salpingo-oophorectomy
Intervention type(s): Procedure; Procedure
Intervention description(s): Laparoscopic bilateral salpingo-oophorectomy; Unilateral oophorectomy was performed immediately after abdominal entry, and the remaining contralateral ovary was excised at the end of the hysterectomy in order to compare the effect of these surgical procedures on ovarian tissue.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Basic Science