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

OBJECTIVE: To evaluate the feasibility and outcome of surgical management of large benign ovarian cysts using ultra-minilaparotomy. METHODS: Twenty-five patients underwent ultra-minilaparotomy that involved a <3 cm skin incision for benign ovarian cysts with maximum diameter > or =10 cm. Patients' characteristics, operative time, estimated amount of blood loss (EBL), operative complications, postoperative outcomes and the pathological findings were examined. RESULTS: The mean age was 37 years (range 19 to 78 years). Body mass index were 23 (range 16 to 34). The maximum diameter of the ovarian cysts ranged from 10 to 28 cm (mean of 12 cm). The mean (range) operative time was 38 minutes (25 to 80 minutes). The median (range) EBL was 40 mL (20 to 120 mL). No patients received blood transfusion. The median (range) post-operative hospital stay was 2 days (1 to 3 days). There were no operative or post-operative complications. The surgical procedures performed were ovarian cystectomy (17 cases), unilateral salpingo-oophorectomy (6 cases) and unilateral oophorectomy (2 cases). The pathology findings include eight endometriotic cysts, seven mucinous cystadenoma, five dermoid cysts, four serous cystadenoma and one ovarian fibroma. CONCLUSION: Utra-minilaparoptomy is feasible and safe minimally invasive strategy for managing patients with large ovarian cysts.
Blood Transfusion ; Body Mass Index ; Cystadenoma, Mucinous ; Cystadenoma, Serous ; Cystectomy ; Dermoid Cyst ; Female ; Humans ; Laparotomy ; Length of Stay ; Operative Time ; Ovarian Cysts ; Ovariectomy ; Postoperative Complications ; Skin

OBJECTIVE: The aim of this study was to estimate the feasibility, safety and surgical outcomes of single port access laparoscopic myomectomy (SPA-M). METHODS: We reviewed the medical records of 29 patients with uterine leiomyoma who underwent SPA-M in Gumi CHA hospital between March 2010 and August 2010. We performed SPA-M with conventional rigid straight laparoscopic instruments in all cases. RESULTS: In this study, the mean of leiomyoma weight, operating time, and estimated blood loss were 55.43 gm(+/-54.79, range 5~220 gm), 69.68 min (+/-32.99, range 20~120 min.), 100 mL (+/-104.26 range minimal~300 mL), respectively. Transfusion was done in the one case. CONCLUSION: SPA-M using conventional rigid straight laparoscopic instruments was feasible and could be an alternative to conventional multi-port access laparoscopic myomectomy (MPA-M).
Humans ; Leiomyoma ; Medical Records

OBJECTIVE: The purpose of this study was to compare the safety, morbidity, and recurrence rate of laparoscopic radical hysterectomy (LRH) with lymphadenectomy and abdominal radical hysterectomy with lymphadenectomy (ARH) for IB1 cervical cancer. METHODS: We conducted retrospective analysis of 91 consecutive patients with FIGO stage IB1 cervical cancer who underwent laparoscopic or abdominal radical hysterectomy with pelvic and/or para-aortic lymphadenectomy between 2006 and 2009. RESULTS: Thirty-two patients undergoing LRH and 59 patients undergoing ARH. There was no difference in demographic data between the two groups. Mean estimated blood loss was 567.9 mL with ARH group compared with 429 mL with LRH group (p=0.001). Mean operating time was 242.0 minutes for ARH group compared with 249.5 minutes for LRH group (p=0.597). Return of bowel motility was observed earlier after LRH (p=0.013). A mean 22.8 pelvic lymph nodes were obtained during ARH compared with 21.6 during LRH (p=0.573). The median duration of hospital stay was significantly shorter for LRH (p=0.016) group. No statistically significant difference was found between the two groups when the recurrence rate was compared. Progression-free survival rates were 94.9% in ARH group and 94.4% in LRH group respectively (p=0.9317). With a median follow up of 17.9 months, all the patients are alive with no disease-related deaths. CONCLUSION: LRH is a safe and effective therapeutic procedure for management of Ib1 cervical cancer with reducing blood loss, postoperative morbidity, and postoperative hospital stay and oncologic results of this procedure are comparable to ARH with the limitation of a short follow-up period. Further randomized studies are necessary to evaluate long-term clinical outcome.
Disease-Free Survival ; Follow-Up Studies ; Humans ; Hysterectomy ; Length of Stay ; Lymph Node Excision ; Lymph Nodes ; Postoperative Hemorrhage ; Prognosis ; Recurrence ; Retrospective Studies ; Uterine Cervical Neoplasms

Levonorgestrel-releasing intrauterine system (LNG-IUS: Mirena(R)) have many important and potential gynecologic applications beyond its role in contraception. This article describes the evidence and results of clinical applications of use of Mirena(R) for gynecologic diseases such as idiopathic menorrhagia, endometriosis, leiomyoma, adenomyosis, endometrial hyperplasia and early endometrial cancer is reviewed.
Adenomyosis ; Contraception ; Endometrial Hyperplasia ; Endometrial Neoplasms ; Endometriosis ; Female ; Genital Diseases, Female ; Leiomyoma ; Menorrhagia

OBJECTIVE: To report the safety and clinical efficacy of laparoscopic myomectomy. METHODS: We analyzed retrospectively the data for 74 laparoscopic myomectomy performed at Inje University Busan Paik Hospital beween 2005 and 2009. With medical records, we analyzed data on the patient's age, parity, BMI, size, weight and location of myoma, previous operative history, preoperative indication, operating time, blood loss, change of hemoglobin concentration from preoperative to postoperative state, hospital stay. RESULTS: The mean age of the patients was 39.5+/-6.9 years, parity was 1.4+/-1.0 and BMI was 22.1+/-2.6 kg/m2. The size of myoma by preoperative ultrasonography was 5.2+/-1.9 cm, the weight of removed myoma was 95.1+/-88.1 g. Most myomas were subserosal and intramural type. The operating time was 95.9+/-34.4 minutes, the change of hemoglobin concentration was 1.3+/-0.78 g/dL, and the hospital stay was 4.7+/-1.1 days. Postoperatively, transfusion was done in 2 cases, one patient was pregnant and underwent an cesarean section delivery during follow-up. CONCLUSION: Laparoscopic myomectomy was performed regardless of the size, the location of the myoma or the previous operative history and had good outcomes without complications in our hospital. Laparosocpic myomectomy is considered safe and reliable procedure in various types of myoma.
Cesarean Section ; Female ; Hemoglobins ; Humans ; Length of Stay ; Medical Records ; Myoma ; Parity ; Pregnancy ; Retrospective Studies