Clinical Evaluation on 763 Cases of Laparoscopically Assisted Vaginal Hysterectomy (LAVH) / 대한산부인과학회지

OBJECTIVE: To report our clinical experience with 763 cases of laparoscopic assisted vaginal hysterectomy (LAVH) and to evaluate the efficacy and advantage of LAVH. METHODS: From Jan. 2000 to Feb. 2006, 763 cases of LAVH were performed at the Department of Obstetrics and Gynecology. we analyzed the results regard to the age, parity, surgical indication, previous abdominal surgery, operation time, weight of uterus, change of hemoglobin, hospital stay, concomitant procedures, and complication. RESULTS: The mean age was 45.7+/-7.1 years. The mean parity was 2.5+/-1.2. The average weight of patients was 58.59+/-9.5 kg. Leiomyoma was the most common surgical indication. Tubal ligation was the most common previous surgery. The mean operation time was 87.5+/-45.7 minutes. The mean hemoglobin change was 1.1+/-0.7 g/dL. The mean uterine weight was 251.34+/-131.5 gm. The mean hospital stay was 6.15+/-0.94 days. The complication rate was 3.4% (26 cases); bladder injury (7 cases), ureter injury (3 cases), vault bleeding (3 cases), trochar site bleeding (13 cases). CONCLUSIONS: LAVH is safe and effective surgical procedure for hysterectomy. The improvement of surgical skill and laparoscopic instrument can make more replace Total abdominal hysterectomy with LAVH.

A Case of Treatment with Methotrexate Local Injection on Intramural Pregnancy within a Previous Cesarean Scar / 대한산부인과학회지

Intramural pregnancy on a cesarean section scar is one of the rarest forms of ectopic pregnancy that may cause serious complications such as uterine rupture and massive bleeding. The common treatment in the past was laparotomy, but today early diagnosis is available thanks to the development of image diagnostic technology and, as a consequence, cases of less invasive conservative management are reported. Using vaginal ultrasonography and MRI, we made an early diagnosis on a case of intramural pregnancy on the scar of a previous cesarean section. We injected methotrexate locally into the gestational sac, and the intramural pregnancy was completely cured. Thus, here we report this case with a brief review of relevant literature.