OBJECTIVE: To compare perioperative outcome of robot-assisted radical hysterectomy with abdominal radical hysterectomy for early-stage cervical cancer and endometrial cancer and to evaluate the feasibility of robotic-assisted radical hysterectomy. METHODS: We reviewed medical record of 37 patients who had radical hysterectomy at Hallym university for cervical cancer stage Ia1 to IIa and endometrial cancer stage Ia to Ib. Abdominal radical hysterectomy was carried out in 27 (Abdominal group) patients and robot-assisted radical hysterectomy carried out in 10 patients (Robotic group). We compared patient's characteristics between two groups. Perioperative characteristics compared included cancer stage, operative time, number of nodes, estimated blood loss, length of hospital stay and complications. RESULTS: There were no differences in age, parity, history of medical disease, body mass index between two groups (p>0.05). Robotic operative times were significantly longer than for abdominal (480.0+/-117.8 vs. 286.9+/-65.6 min, p<0.0001). Blood loss (660.0+/-245.9 vs. 1,137.0+/-608.4 mL. p<0.0001) and length of hospital stay (7.2 versus 17.1 days, p<0.0001) were significantly lower for the robotic group. Lymph node yield in the robotic group was equivalent to that for the abdominal group (30.1+/-8.7 vs. 35.4+/-16.9, p=0.356). No major operative complications occurred with both groups. CONCLUSION: Robot-assisted radical hysterectomy appears safe and feasible in early-stage cervical and endometrial cancer.
Body Mass Index ; Endometrial Neoplasms ; Female ; Humans ; Hysterectomy ; Length of Stay ; Lymph Nodes ; Medical Records ; Operative Time ; Parity ; Uterine Cervical Neoplasms

OBJECTIVE: Patient-controlled-analgesia (PCA) using intravenous (IV) opioids is recognized a safe and effective method for pain control. However, postoperative analgesia with opioids is associated with a high incidence of postoperative nausea and vomiting (PONV) exceeding 30%. The 5-hydroxytryptamine receptor 3 (5-HT3) antagonists alleviate nausea and vomiting. This study aims to compare the effectiveness of ramosetron and ondansetron in preventing PONV following laparoscopic hysterectomy for benign uterine diseases under general anesthesia. METHODS: The medical records of 1483 patients who underwent laparoscopic hysterectomy between January 2005 and May 2009 were reviewed. Of the 1483 patients, 1184 patients who received IVPCA with ramosetron 0.3 mg (n=761) or ondansetron 8 mg (n=423) were analyzed. Fentanyl-based IVPCA was administered for 48 hours after surgery. The overall incidence of postoperative nausea and vomiting, bowel ileus, Levin tube insertion for severe bowel ileus, additional usage of pain killers and discontinuation of the IVPCA infusion with PCA-related severe nausea and vomiting were assessed for 48 hours after surgery. The amount of time until bowel gas passage resumption after surgery was measured. RESULTS: There was a significant difference between the two groups regarding the duration until post-operative bowel gas passage resumption (1.78+/-0.79 days in the ramosetron group, and 2.23+/-0.83 days in the ondansetron group; p=0.005); however, there were no significant differences found in other aspects. CONCLUSION: Ramosetron is superior to ondansetron in terms of faster recovery in bowel mobility, with similar effects in preventing the incidence of PONV.
Analgesia ; Analgesia, Patient-Controlled ; Analgesics, Opioid ; Benzimidazoles ; Humans ; Hysterectomy ; Ileus ; Incidence ; Medical Records ; Nausea ; Ondansetron ; Postoperative Nausea and Vomiting ; Serotonin ; Uterine Diseases ; Vomiting

OBJECTIVE: The purpose of our study is to investigate the feasibility of the laparoscopy and compare perioperative outcomes between laparoscopy and laparotomy in pregnant women with non-malignant ovarian tumor. METHODS: Retrospective comparative analysis of 56 pregnant women who underwent laparoscopy or laparotomy due to non-malignant ovarian tumors at Samsung Medical Center, Seoul, Korea, between October 1994 and December 2010 were performed. RESULTS: Among 56 patients, 22 and 34 pregnant women underwent laparotomy and laparoscopy, respectively. There were no statistically significant differences between the two groups about general characteristics including age, gestational age, torsion, surgeon type, pain at diagnosis and clinical outcomes including tocolytics use, operation type, operation time, the ratio of normal full-term vaginal delivery, Apgar score. However, pathological longest tumor size was larger in laparotomy group than laparoscopy group (9.0 cm vs. 5.8 cm; p=0.001) and laparoscopy was related with significantly less estimated blood loss (200 vs. 50 mL; p=0.001) and short hospital days (7 vs. 4 days; p<0.001). CONCLUSION: Laparoscopy for the treatment of non-malignant ovarian tumors in pregnant women is feasible and has benefits such as less estimated blood loss during the surgery and hospital stays when compared with laparotomy. However, laparoscopic adnexal surgery for large tumor size may be still challenging in pregnant women.
Apgar Score ; Female ; Gestational Age ; Humans ; Korea ; Laparoscopy ; Laparotomy ; Length of Stay ; Pregnancy ; Pregnant Women ; Retrospective Studies ; Tocolytic Agents

OBJECTIVE: To compare clinical features and surgical outcomes of laparoscopic-assisted vaginal hysterectomy (LAVH) by the number of ports in the treatment of uterine myoma and adenomyosis. METHODS: Between 1st January 2009 and 31th March 2010, 50 patients underwent 5 mm-2 port LAVH and 10 mm-3 port LAVH respectively by same surgeon at Chosun university hospital. We compared clinical features and surgical outcomes. RESULTS: There was no difference in weight of uterus between the 5 mm-2 port LAVH group and the 10 mm-3 port LAVH group (465.2+/-206.9 g vs. 470.8+/-148.5 g) (Mean+/-S.D.), and in amounts of blood loss during procedure between the two groups (115.0+/-179.3 mL vs. 125.0+/-211.7 mL). The duration of procedure showed a difference between the two groups(55.1+/-12.0 minutes vs. 60.4+/-19.5 minutes) (p=0.03). In the 5 mm-2 port LAVH group, 2 of 50 (4%) converted to laparotomy, and 1 of 50 (2%) in the 10 mm-3 port LAVH group. There was no difference in length of postoperative hospital day between the two groups (5.8+/-1.0 days vs. 6.3+/-1.6 days). In the comparison of postoperative complications, 1 of 50 (2%) required readmission and reoperation for both of the two groups. CONCLUSION: We conclude that 5 mm-2 port LAVH could be a available method in the treatment of uterine myoma and adenomyosis.
Adenomyosis ; Female ; Humans ; Hysterectomy, Vaginal ; Laparotomy ; Myoma ; Postoperative Complications ; Reoperation ; Uterus

Since 2008, various single-port access laparoscopic surgeries in gynecologic diseases have been performed in Korea. Single-port laparoscopic surgery has some advantages. It has less visible scars, less pain, and a faster recovery. Single-port laparoscopic surgery also has a drawback that is hard to handle instruments compared to conventional multi-port laparoscopic surgery. However, single-port laparoscopic surgery can be performed safely by practitioners who have experiences in single-port laparoscopic techniques. Based on experiences of gynecologic single-port laparoscopic surgery for 1000 cases in Incheon St. Mary's Hospital until August 2011, we describe techniques for single-port access laparoscopic surgery.
Cicatrix ; Female ; Genital Diseases, Female ; Korea ; Laparoscopy ; Umbilicus

In case of intrauterine pregnancy with an intrauterine device (IUD), it is recommended to remove the device because of the increased risk of abortions, septic complications and premature delivery. But removal of intrauterine devices in early pregnancy remains a troublesome problem for both doctors and patients, especially when IUD threads are not visible at the external os. If the thread of the IUD is not visible, extraction with hysteroscopy and ultrasonic guidance is advised. But due to postoperative complications such as uterine rupture or bleeding and electrolyte imbalance, many doctors prefer not to perform the procedure. IUD removal is scarcely performed that there are only 2 successful cases which were reported in Korea until today. Recently we experienced a case of an early pregnant woman with IUD in whom thread was invisible at the cervical os and IUD removal was attempted and successfully performed by ultrasound guided hysteroscopy. Pregnancy was maintained without complications until 39th week and delivered healthy baby. So we report this case with the review of articles related.
Abortion, Septic ; Female ; Hemorrhage ; Humans ; Hysteroscopy ; Intrauterine Devices ; Korea ; Postoperative Complications ; Pregnancy ; Pregnant Women ; Ultrasonics ; Uterine Rupture

Because of the organized screening programs, incidence and mortality of cervical cancer has been decreased and cervical cancer is diagnosed in relatively young age women and early stages. Traditional treatments for early cervical cancer are radical hysterectomy or chemoradiation, which irreversibly destroy reproductive capacity. Radical vaginal trachelectomy could be an alternative option for young women with early cervical cancer wishing to preserve fertility. Here, we report 2 cases of our initial experiences with Laparoscopy-Assisted Radical Vaginal Trachelectomy (LARVT) for patients with cervical cancer stage I. Two cases of 29 and 31-year-old nulliparous women were diagnosed with cervical cancer IA1-IA2. They underwent LARVT with permanent cervicoisthmic cerclage with 3 cycles of adjuvant chemotherapy. LARVT can be the procedure of choice for women with early stage cervical cancer who desire a fertility preservation.
Adult ; Chemotherapy, Adjuvant ; Female ; Fertility ; Fertility Preservation ; Humans ; Hysterectomy ; Incidence ; Mass Screening ; Uterine Cervical Neoplasms

OBJECTIVE: To evaluate the effectiveness of single preoperative dose of misoprostol to reduce intraoperative hemorrhage during laparoscopic myomectomy. METHODS: We reviewed retrospectively the medical records of 148 patients who underwent laparoscopic myomectomy in Gangnam CHA Medical Center between January 2007 and December 2009 by single surgeon. Among them, 46 patients used preoperative transrectal misoprostol. One hundred two patients underwent laparoscopic myomectomy in conventional method without any preoperative agents. RESULTS: The two groups were similar in baseline characteristics. There was no significant difference in mean blood loss (misoprostol group: 203.3+/-181.8 mL vs. no agent group: 207.7+/-144.5 mL), operation time (misoprostol group: 113.3+/-28.2 min vs. no agent group: 113.4+/-31.5 min), and hemoglobin change (misoprostol group: 2.0+/-1.0 g/dL vs. no agent group: 1.9+/-1.0 g/dL). Two patients needed transfusion in misoprostol group whereas none in control group, but there was no statistical significance. CONCLUSION: A single preoperative dose of transrectal misoprostol cannot reduce bleeding during laparoscopic myomectomy.
Hemoglobins ; Hemorrhage ; Humans ; Medical Records ; Misoprostol ; Retrospective Studies

OBJECTIVE: We investigated the clinical value of using preoperative differential white blood cell (WBC) count to predict the potential for malignancy of adnexal masses in laparoscopic surgery. METHODS: The electronic medical records of 1325 patients who underwent laparoscopic surgery for adnexal masses between July 2005 and December 2008 were analyzed retrospectively. RESULTS: Of 1325 patients, 30 (2.3%) had adnexal masses with malignant potential. Analysis of differential WBC count, neutrophil to lymphocyte ratio (NLR), neutrophil to monocyte ratio (NMR), serum CA 125, mass size showed that only cyst size was significantly different between patients with potentially malignant adnexal masses, those with benign disease (averages of 9.45 cm vs. 6.23 cm, p=0.001). Further analysis was performed using a combination of various markers and multiplication of cyst size and NMR yielded the highest area under the curve, at 0.711(95% confidential interval 0.619~0.806, p<0.001), with a sensitivity and specificity of 86.7% and 48.3% respectively, at a cut off value of 67.23. These values were also significantly different between patients with potentially malignant adnexal masses, and dermoid cyst or endometrioma (p=0.038 and 0.002 respectively, by analysis of variance, post hoc test). CONCLUSION: Preoperative measurement of NMR in conjunction with cyst size may be used as a simple, non invasive marker for predicting the malignant potential of adnexal masses before laparoscopic surgery.
Dermoid Cyst ; Electronic Health Records ; Endometriosis ; Female ; Humans ; Laparoscopy ; Leukocytes ; Lymphocytes ; Monocytes ; Neutrophils ; Sensitivity and Specificity

OBJECTIVE: Adhesion barrier has been commonly used in gynecologic surgery. The objective of this study is to evaluate the outcome of applying adhesion barrier in preventing adhesion formation after laparoscopic surgery. METHODS: Between March 2000 and March 2010, we retrospectively reviewed the medical records of patients who performed laparoscopic surgery twice at Samsung Medical Center. The patients to whom adhesion barrier was applied at the end of the first laparoscopic surgery and had imaging files of pelvic cavity at second laparoscopic surgery were included. The patients with recurrent endometriosis and pelvic inflammatory disease which can make postoperative adhesion by itself due to the nature of the disease were excluded. RESULTS: Ten patients were eligible to be analyzed. Only 3 among 10 showed adhesion free and we could find de novo adhesion formation in 7 patients at second laparoscopic surgery. Eight patients used Intercede(R) (oxidized regenerated cellulose mesh; Johnson & Johnson, New Brunswick, NJ, USA) and two patients used Guardix(R) (sodium hyaluronic acid solution and carboxymethylcellulose: Hanmi, Seoul, Korea). In six patients, adhesion formation was found at the operation site and one patient showed postoperative adhesion distant from operation site between omentum and anterior peritoneum of pelvic wall. CONCLUSION: We observed adhesion formation despite of prior use of adhesion barrier after laparoscopic gynecological surgery. These results suggest that the use of adhesion barrier alone after gynecologic laparoscopic surgery may not guarantee adhesion prevention.
Cellulose ; Endometriosis ; Female ; Gynecologic Surgical Procedures ; Humans ; Hyaluronic Acid ; Laparoscopy ; Medical Records ; New Brunswick ; Omentum ; Pelvic Inflammatory Disease ; Peritoneum ; Retrospective Studies