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

Nowadays, various techniques of minimally invasive surgery have been developed and a trend to perform less invasive surgery is accelerated. Reducing number of trocar insertion sites and scars is one example of this trend. Recently, single port laparoscopic surgery (SPLS) through one umbilical incision has been developed. This technique is adopted to various operations for adnexal and uterine surgery and initial reports on this novel technique have been published. Single port laparoscopic surgery is a novel technique of minimally invasive surgery and it has become more popular in gynecologic surgery field during recent years. In this article we review instrument and techniques for SPLS and we also review recent published articles for elucidating the evidence of this novel technique.
Cicatrix ; Female ; Gynecologic Surgical Procedures ; Laparoscopy ; Surgical Instruments

OBJECTIVE: Fourteen cases of vaginal vault evisceration after total laparoscopic hysterectomy were presented. We review pertinent literature, discuss precipitating causes, clinical manifestations, and management that was performed. METHODS: We reviewed medical records of 14 women with vaginal vault evisceration after total laparoscopic hysterectectom between March 2000 and October 2012 at 4 hospitals of CHA University. RESULTS: Between March 2000 and March 2006, 1,887 women underwent total laparoscopic hysterectomy and 12 vaginal vault eviscerations (0.6%) were presented. Thereafter, only two new cases were presented. The precipitating event was coitus in nine cases (64%), sit-ups in two cases (14%), spontaneous (urine ascites), lymphatic ascites, and unknown in one case (7%) each. Prolapsed organs were small bowels, omentum, and salpinx. Common presenting symptoms were pain, bleeding, watery discharge, and protruded mass (bowels). Eleven women underwent transvaginal repair (79%) - two laparotomic (14%) and one laparoscopic (7%), and none have exhibited sequelae. CONCLUSION: Coitus was the triggering event in most cases. For vaginal vault evisceration following total laparoscopic hysterectomy, vaginal repair should be first considered.
Ascites ; Coitus ; Fallopian Tubes ; Female ; Hemorrhage ; Humans ; Hysterectomy ; Hysterectomy, Vaginal ; Medical Records ; Omentum

OBJECTIVE: To evaluated the result of laparoscopic surgery of adnexal tumors and removing excised tissue through Douglas pouch incision. METHODS: 110 patient who had visited Chosun University Hospital department of Obstetrics and Gynecology between January, 2011 to April, 2012 were involved in the study. Patient had laparoscopic surgery on the adnexal tumor and excised tissue was removed through Douglas pouch incision by single surgeon. RESULTS: The mean age of patients were 41.5 years. The size of the tumor varied from 3 cm to 27 cm in size using ultrasonography. The mean operation time was 61.3 minutes and the mean admission period was 4.2 days. 82 patient had salpingo-oophorectomy or oophorectomy, 19 had ovarian cystectomy, 2 had wedge resection and 4 had tumor enucleation. Histologic result reveal endometriosis in 23 patients (20.9%). teratoma in 21 (19%), serous cystadenoma in 14 (12.7%) and mucinous cystadenoma in 10 (9.1%). Other histologic finding includes hemorrhagic cyst, luteal cyst and paratubal cyst. There was no complication including bladder or rectal injury, suture site infection. CONCLUSION: Laparoscopic surgery of adnexal tumor and removal by Douglas pouch incision is a simple, safe and efficient method that could be considered as an alternative minimally invasive technique.
Cystadenoma, Mucinous ; Cystadenoma, Serous ; Cystectomy ; Douglas' Pouch ; Endometriosis ; Female ; Gynecology ; Hospital Departments ; Humans ; Laparoscopy ; Obstetrics ; Ovariectomy ; Parovarian Cyst ; Sutures ; Teratoma ; Urinary Bladder

OBJECTIVE: To analyze the clinical experiences of patients who treated with levonorgestrel-releasing intrauterine system (LNG-IUS) for adenomyosis associated with dysmenorrhea and/or menorrhagia. METHODS: The LNG-IUS was inserted into 103 patients who were diagnosed with adenomyosis on ultrasound examination and suffered from dysmenorrhea or menorrhagia at CHA Gangnam Medical Center between January 2009 and December 2009. Symptomatic changes of dysmenorrhea and menorrhagia, side effects, and failure rates were evaluated, retrospectively. RESULTS: During the follow-up periods, dysmenorrhea was improved in 91.4% and menorrhagia was improved in 90.4% of patients. Most common side effects were prolonged vaginal spotting in 41 (39.8%), and expulsion of LNG-IUS in 32 (31.1%) patients. Six (5.7%) patients were premature removal of LNG-IUS and 9 (8.5%) patients were underwent hysterectomy. Overall 77 (74.8%) patients continued to use of LNG-IUS. CONCLUSION: The LNG-IUS is effective treatment option for management of dysmenorrhea and menorrhagia for patients with clinical diagnosis of adenomyosis. It seemed to be an alternative treatment method before hysterectomy.
Adenomyosis ; Dysmenorrhea ; Female ; Follow-Up Studies ; Humans ; Hysterectomy ; Menorrhagia ; Metrorrhagia

OBJECTIVE: To compare clinicopathologic characteristics and surgical outcomes of laparoscopic surgery in women with endometrial cancer according to body mass index (BMI). METHODS: From June 2009 to October 2010, prospective observational study without randomization of 159 patients treated by laparoscopic surgery from 10 hospitals nationwide. RESULTS: Patients were divided according to the WHO guidelines for Asia-Pacific populations and the distributions of BMI were as follows: 3 patients (1.9%) in underweight (BMI < 18.5 kg/m2), 50 patients (31.4%) in normal weight (BMI, 18.5-22.9 kg/m2), 45 patients (28.3%) in overweight (BMI, 23.0-24.9 kg/m2), 49 patients (30.8%) in obese (BMI, 25.0-29.9 kg/m2), and 12 patients (7.5%) in morbid obese (BMI > or = 30.0 kg/m2). Age, history of previous surgery, surgery extend, and history of previous surgery were not different between non-obese patients (BMI < 25.0 kg/m2) and obese patients (BMI > or = 25.0 kg/m2). Co-morbidities were more common in obese patients but marginally significant (23.5% vs. 37.7%, p=0.072). Four patients (2.5%) were converted to abdominal surgery because of severe adhesion. Regarding to surgical outcomes, operation time was significantly longer in obese patients (199 min vs. 235 min, p=0.013) but blood loss, lymph node yield, hospital stay, Foley removal, transfusion rate and peri-operative complication were not statistically significant. Regarding to pathologic results, there were no difference in terms of lymphovasucular space invasion, tumor grade, histologic type, lymph node metastasis and FIGO stage. CONCLUSION: Clinicopathologic characteristics and surgical outcomes does not seem to be significantly influenced by BMI except operation time. So the laparoscopic approach can be the alternative method for obese patients.
Body Mass Index ; Endometrial Neoplasms ; Female ; Humans ; Laparoscopy ; Length of Stay ; Lymph Nodes ; Neoplasm Metastasis ; Obesity ; Overweight ; Prospective Studies ; Random Allocation ; Thinness

OBJECTIVE: This study was designed to assess the actual circumstances of post-operative anemia and associating factors, during the laparoscopic myomectomy. METHODS: A retrospective chart review of 172 patients who underwent laparoscopic myomectomy from 2008 to 2009 was performed. Characteristics of patients (age, parity, body mass index, and preoperative gonadotropin releasing hormone agonists injection) and fibroids (the largest diameter, number, width, type and location), and surgical outcomes (operating time, pre- and post-operative hemoglobin level, blood loss, hospital stay, and complications, including transfusion) were retrieved. RESULTS: One patient (0.6 %) required transfusion and significant hemoglobin change (> or =2.0 g/dL) occurred in 45 patients, after laparoscopic myomectomy. The largest diameter, width, type, and location of fibroids, and pre-operative gonadotropin releasing hormone agonist injection were not associated with the hemoglobin change (p=0.193, 0.172, 0.764, 0.741, and 0.954 respectively). Multivariate analysis revealed that nulliparity (p=0.195, 95% confidence interval (CI): 0.286-1.291) was not a risk factor, but long operating time (> or =90 min; p=0.048, 95% CI: 1.008-5.054) and multiple myoma (> or =3 in number; p=0.009, 95% CI: 1.320-6.717) were independent risk factors for significant hemoglobin change. CONCLUSION: In our data, symptomatic anemia after laparoscopic myomectomy was uncommon. In addition, the only useful predictive factor for hemoglobin change during the laparoscopic myomectomy was a multiplicity of myoma.
Anemia ; Body Mass Index ; Female ; Gonadotropin-Releasing Hormone ; Hemoglobins ; Humans ; Leiomyoma ; Length of Stay ; Multivariate Analysis ; Myoma ; Parity ; Retrospective Studies ; Risk Factors

OBJECTIVE: To evaluate the feasibility of laparoscopic salpingectomy using one-port in tubal pregnancy compared to conventional laparoscopic surgery. METHODS: From June 2008 to June 2011, 63 women were treated with laparoscopic salpingectomy due to tubal pregnancy, which was diagnosed by ultrasonography. These patients were divided into two groups. Of these 63 patients, 32 women were treated with conventional laparoscopic salpingectomy (CLS) in group I, 31 women underwent laparoscopic salpingectomy using one port (OPLS) in group II. In group I, rigid 0degrees or 30degrees, 10 mm laparoscope, rigid instruments were used. In group II, 30degrees, 10 mm laparoscope, rigid or flexible angulated tip instruments were used during the surgery. We reviewed and compared clinical characteristics, clinical outcomes of these patients. RESULTS: Patients in Group I were compatible with the patients in group II in clinical characteristics. Clinical outcomes were not different between two groups in terms of Hemoglobin change (g/dL), hospital stay (days), hemoperitoneum (mL), transfusion. Mean operative time was significantly longer in group II (59.7+/-15.7 min vs. 46.5+/-15.0 min, p=0.001). The mean length of skin incision was obviously shorter in group II; the difference was highly statistically significant (15.5+/-3.0 mm vs 23.5+/-3.0 mm, p<0.001). CONCLUSION: It seems that OPLS is feasible alternative to CLS to treat hemodynamically stable patients without complications. Additionally, this technique also results in better cosmetic outcomes than CLS. Randomized prospective clinical studies with larger scale are necessary in the future to confirm these results.
Cosmetics ; Female ; Hemoglobins ; Hemoperitoneum ; Humans ; Laparoscopes ; Laparoscopy ; Length of Stay ; Operative Time ; Pregnancy ; Pregnancy, Tubal ; Salpingectomy ; Skin

OBJECTIVE: To assess the prognostic factors of early endometrial cancer. METHODS: Medical records of patients with endometrial cancer stage I and II were reviewed retrospectively between 1999 and 2005. Progress-free survival rates of each prognostic factor were obtained. RESULTS: The mean age of 45 patients was 49 (27-74). Thirty-nine patients had stage I, 6 patients had stage II of the disease. Most cases of histology were diagnosed with endometrioid adenocarcinoma (42 patients, 93.3%). Twenty-three patients had grade 1, 16 patients had grade 2, and 6 patients had grade 3 histology. Thirty patients had myometrial invasion of less than 50%, while 15 patients had myometrial invasion of more than 50%. Thirty-one patients showed no lympho-vascular space involvement (LVSI), and 14 patients were LVSI positive. All patients were primarily treated by surgery. Twenty-four patients received adjuvant radiotherapy, and 1 patient received concurrent chemotherapy and radiotherapy. In univariate analysis, FIGO stage (p=0.004), tumor grade (p=0.043), myometrial invasion (p=0.030), and LVSI (p=0.003) had statistical significance with PFSR. However, age, parity, menopause, lymphadenectomy, and histology did not. CONCLUSION: Stage, tumor grade, myometrial invasion, and LVSI seemed to be statistical prognostic factors in early endometrial cancer.
Carcinoma, Endometrioid ; Endometrial Neoplasms ; Female ; Humans ; Lymph Node Excision ; Medical Records ; Menopause ; Parity ; Radiotherapy, Adjuvant ; Retrospective Studies ; Survival Rate

OBJECTIVE: To compare surgical outcomes of patients with myoma after robot-assisted laparoscopic myomectomy and laparoscopic myomectomy. METHODS: Retrospective chart review of 15 robot-assisted laparoscopic myomectomy (RLM) patients and 30 laparoscopic myomectomy (LM) patients at Jeju National University Hospital in Jeju between July 2009 and July 2012. Clinical features and surgical outcomes were compared. RESULTS: Surgical time was longer among RLM patinets (185.7 min vs 114.4 min). Patients undergoing robot-assisted myomectomy had a bigger size of the largest myoma, and bigger average size of the myomas. When adjusted for myoma size and number, no significant differences were noted between robotic (RLM: 24.5 min/cm) vs laparoscopic (LM: 21.5 min/cm) groups for mean operating time/total diameter. Blood loss (1.7 g/dl vs 1.95 g/dl), transfusion (0% vs 6.6%) were both no significant differences between the robotic and laparoscopic groups. CONCLUSION: When adjusted for myoma size and number, short-term outcomes were similar after robotic and laparoscopic myomectomy. Robot-assisted myomectomy is considered reliable procedure.
Humans ; Laparoscopy ; Myoma ; Operative Time ; Retrospective Studies