Robotic Single-Site Hysterectomy versus Robot-Assisted Multiport Hysterectomy in Benign Gynecologic Diseases: A Retrospective Comparison of Clinical and Surgical Outcomes

OBJECTIVE: The purpose of this study was to compare clinical and surgical outcomes of robotic single-site hysterectomy (RSSH) and robot-assisted multiport hysterectomy (RH) in benign disease. METHODS: We retrospectively reviewed the medical records of 38 women who underwent RSSH (N=12) or RH (N=26) for the treatment of benign uterine disease between June 2015 and November 2017. RESULTS: There were no intergroup differences in parity, comorbidities, and number of previous abdominal surgery. Mean age was older (49.5±5.05 years vs. 44.4±3.54 years, P=0.001) and mean body mass index was higher (27.4±2.47 kg/m2 vs. 25.3±3.12 kg/m2, P=0.045) in RSSH group than RH group. Surgical outcomes, including operative time (165.0 minutes vs. 159.2 minutes, P=0.727), estimated blood loss (115.8±33.15 mL vs. 108.1±56.42 mL, P=0.662), uterus weight (445.9±157.21 g vs. 374.5±197.91 g, P=0.291), postoperative hospital stay (5.4±0.51 days vs. 5.8±1.20 days, P=0.289), postoperative hemoglobin change in day 1 (1.8±0.89 g/dL vs. 1.4±1.53 g/dL, P=0.431) and day 3 (2.1±1.32 g/dL vs. 1.7±1.83 g/dL, P=0.601), and perioperative complications did not significantly differ between two groups. The use of additional analgesics after 6 hours, 24 hours, and 48 hours, and mean NRS score after 6 hours, 24 hours, and 48 hours were not significantly different between two groups. CONCLUSION: RSSH might be an effective and safe alternative to RH, even if in older and/or obese women with large uteri.

Comparison of HE4, CA125, and Risk of Ovarian Malignancy Algorithm in the Prediction of Ovarian Cancer in Korean Women

This study is a multi-center clinical study, which aimed to compare CA125, HE4, and risk of ovarian malignancy algorithm (ROMA) in predicting epithelial ovarian cancer of Korean women with a pelvic mass. Prospectively, serum from 90 Korean women with ovarian mass was obtained prior to surgery. For control group, serum from 79 normal populations without ovarian mass was also obtained. The HE4 and CA125 data were registered and evaluated separately and ROMA was calculated for each sample. Total 67 benign tumors and 23 ovarian cancers were evaluated. Median serum levels of HE4 and CA125, and ROMA score were significantly higher in patients with ovarian cancer than those with benign ovarian tumor and normal population (P < 0.001). In ROC curve analysis for women with a pelvic mass, area under the curve (AUC) for HE4 and ROMA was higher than CA125. Statistical differences in each study compared to CA125 were marginal (P compared to CA125; 0.082 for HE4 and 0.069 for ROMA). Sub-analysis revealed that AUC for HE4 and ROMA was higher than AUC for CA125 in post-menopausal women with a pelvic mass, but there were no statistically significant differences (P compared to CA125; 0.160 for HE4 and 0.127 for ROMA). Our data suggested that both HE4 and ROMA score showed better performance than CA125 for the detection of ovarian cancer in women with a pelvic mass. HE4 and ROMA can be a useful independent diagnostic marker for epithelial ovarian cancer in Korean women.

Two cases of immature teratoma / 대한산부인과학회지

About 20~30% of benign or malignant tumors of ovarian origin arise from embryonic cells, and only 3% represent malignancy. But under age of 20, 70% of ovarian tumors arise from embryonic cells, and over 1/3 of them are malignant tumors. Over all the ovarian tumors arising from embryonic cells, immature teratoma is germ cell tumor, components include immature tissues and cells derived from ectoderm, mesoderm, and endomermal origins. Most of the immature tissues are from neuroectodermal origins. The immature teratoma of the ovary is a rare tumor, representing less than 1% of all ovarian neoplasm. These tumors typically present in young age woman (mean age 10~20 years) with pelvic and abdominal pain. Nowadays newly developed combination chemotherapeutic agents such as bleomycin, etoposide, cisplatin give us great survival and disease free prognosis than before. We have experienced two cases of immature teratoma so we report them with a brief review of concerned literatures.

Follicular stimulating hormone enhances Notch 1 expression in SK-OV-3 ovarian cancer cells / 부인종양

OBJECTIVE: Notch is known as a transmembranous receptor family with four homologous forms - Notch 1, Notch 2, Notch 3, and Notch 4 and related to cell fate regulation and angiogenesis. The purpose is to investigate the effect of follicular stimulating hormone (FSH) on the Notch 1 expression and proliferation in ovarian cancer cells. METHODS: Human ovarian cancer cell line, SK-OV-3 and FSH were used. XTT cell proliferation and cell migration assay were carried out with FSH 100 mIU/mL and Notch 1 siRNA. Western blots and reverse transcriptase-polymerase chain reactions (RT-PCR) were carried out to determine the expression level of the Notch 1 protein and mRNA with FSH treatment in 0, 1, 5, 10, 100, 200, 300 mIU/mL concentrations. Immunofluorescent (IF) stains were performed in SK-OV-3 cell cultures with FSH 100 mIU/mL. Student-t tests were used in statistical analyses. RESULTS: The SK-OV-3 have Notch 1 receptors in their natural status. FSH stimulated SK-OV-3 cells in XTT cell proliferation and cell migration assays and notch 1 siRNA inhibited. The expression level of Notch 1 protein and mRNA were increased in a dose dependent pattern according to FSH concentrations compared to untreated cells. IF stains also showed brighter Notch1 expressions in the FSH treated cells compared to the control cells. CONCLUSION: FSH enhances proliferation & migration and Notch 1 signaling in SK-OV-3 cells. The Notch signaling probably supports one of the cell proliferating mechanisms of FSH in ovarian cancer cells.

A case of pelvic actinomyosis presenting as an advanced ovarian malignancy / 대한산부인과학회지

Pelvic actinomycosis is an infrequent chronic suppurative granulomatous disease, caused by a gram-positive bands Actinomyces israelii. It is often reported as a complicated case of an intrauterine device (IUD). Ureteral obstruction and subsequent hydronephrosis are rare complications of pelvic inflammatory disease. Sometimes pelvic actinomyosis is simulating ovarian malignancy. We report a case combined with hydronephrosis, multiple pelvic lymph nodes enlargements and elevated CA 125 as complications of pelvic actinomycosis.

A case of pelvic actinomyosis presenting as an advanced ovarian malignancy / 대한산부인과학회지

Pelvic actinomycosis is an infrequent chronic suppurative granulomatous disease, caused by a gram-positive bands Actinomyces israelii. It is often reported as a complicated case of an intrauterine device (IUD). Ureteral obstruction and subsequent hydronephrosis are rare complications of pelvic inflammatory disease. Sometimes pelvic actinomyosis is simulating ovarian malignancy. We report a case combined with hydronephrosis, multiple pelvic lymph nodes enlargements and elevated CA 125 as complications of pelvic actinomycosis.

A case of lymphangioleiomyomatosis originated in the pelvic cavity / 부인종양

Lymphangioleiomyomatosis is a rare disease that is characterized by proliferation of abnormal smooth muscle-like cells, especially that which occurs in the pulmonary parenchyme. It primarily affects women of child-bearing age. The majority of primary lymphangioleiomyomatosis occurs in the lung, but there are a few reports of extrapulmonary cases. We experienced a rare case of lymphangioleiomyomatosis which originated in the pelvic cavity (in the posterior portion of the uterus), and report with brief review of literatures.

Solitary mesenteric recurrence of ovarian cancer / 대한산부인과학회지

In epithelial ovarian cancer, solitary metastasis to mesentary is rare in the absence of apparent disease in other sites. We experienced one patient who developed isolated, solitary mesenteric metastasis of epithelial ovarian adenocarcinoma and underwent segmental resection of small bowel including mesentary to remove the recurrent disease. Rising CA125 heralded the recurrence and the patient was subsequently documented by computed tomography (CT) and PET-CT of the abdomen and pelvis with a high signal density noted only in the mesentery. There was no major postoperative complicathion. Solitary recurrence of epithelial ovarian cancer can occur in the absence of other demomstrable metastasis, so we report with brief review of literature.

A Case of maternal metastatic Brain Tumor was detected in Midtrimester / 대한산부인과학회지

Hyperemesis gravidarum is a complication defined as nausea and vomiting during early pregnancy. Atypical hyperemesis syndrome is caused any other problems. Specially, brain tumors is confused hyperemetic symptom in pregnancy. In this case vomiting and mild headache were the only signs. Atypical hyperemesis syndrome is recommand MRI image study for detection of neurologic problem. Following the diagnosis of a brain tumor during pregnancy and management should be tailored to the individual patient. It must be considered to maternal state and fetal maturation. To minimize cerebral herniation in neurologically unstable patient, a consideration should be made for cesarean section delivery with patient under general anesthesia.

A Case of Vaginal Bleeding after Cesarean Section due to Arteriovenous Malformation (AVM) of Uterus / 대한주산의학회잡지

Uterine arteriovenous malformations are very rare but potentially life threatening lesions. These lesions may be congenital or acquired, but especially occur in patients with a history of curettage, abortion or pregnancy. Color doppler ultrasonography is the preferred method of diagnosing of arteriovenous malformations. In many cases, hysterectomies are performed. But if patients want pregnancies, embolization therapy and conservative treatment are effective therapy. We have experienced a clinical case of uterine arteriovenous malformation, which is presented with a brief review of literature.

A Case of Synchronous Existence of Endometrial cancer and Cervical cancer / 대한산부인과학회지

The synchronous existence of endometrial cancer and cervical cancer is very rare. The reported frequency of concurrent gynecologic neoplasms has ranged from 0.7% to 4.3%, synchronous primary tumors of the female genital tract are relatively rare, comprising only 0.49% to 1.7% of all genital neoplasms. The majority of synchronous multiple primary neoplasm of female reproductive tract are of endometrial and ovarian origin. Multiple primary neoplams involving uterine cervix and endometrium were regarded as rare entity. We experienced a rare case of multiple primary neoplasm involving uterine cervix and endometrium and report with brief review of literatures.

The efficacy of nuchal translucency with free beta-hCG, PAPP-A as a screening test for detection of chromosomal anomaly in the first trimester of pregnancy / 대한산부인과학회잡지

OBJECTIVES: The aim of this study is to determine the efficacy of nuchal translucency in combination with free beta-hCG, PAPP-A in the first trimester screening for chromosomal anomaly in general population. METHODS: Between April 1998 and December 1999, we evaluated 263 pregnant women undergoing first trimester screening test for fetal chromosomal anomaly using nuchal translucency combined with free beta-hCG, PAPP-A. We confirmed the pregnancy outcomes through chorionic villi sampling, amniocentesis or term delivery. We excluded 15 pregnant women because of their obscure pregnancy outcomes. Statistical analysis was considered significant when P value was lower than 0.05. RESULTS: With a risk cut-off of 1 in 400, 24 pregnancies(9.7%) of 248 cases were screen positive and 224 pregnancies(90.3%) were screen negative. 2 cases of Down syndrome and 1 case of Turner syndrome were detected in screen positive group. No chromosomal anomalies were detected in screen negative group. CONCLUSION: In this study, 8.57% of false positive rate and 12.5% of positive predictive value were obtained in the first trimester screening for chromosomal anomaly using nuchal translucency and serum markers.

Cyclooxygenase-2 Expression in Ovarian Tumors / 대한산부인과학회잡지

OBJECTIVE: A large body of evidence suggests that cyclooxygenase-2 (COX-2) is important in tumorigenesis of gastrointestinal and other cancers. This was the study to determine whether COX-2 was also expressed in benign and malignant ovarian tumors. METHODS: We studied the expression of COX-2 in various ovarian tumors [ Benign epithelial tumors (n=10), borderline epithelial tumors (n=12), malignant epithelial tumor (n=12), nonepithelial tumors(n=10) ] by immunohistochemistry. Results of immunoreactivity was classified semiquantitatively based on the proportion and intensity of tumor cell immunostaining. RESULTS: In the epithelial ovarian tumors, the intensity of immunostaining was stronger in the malignant tumors than the benign and borderline tumors (p<0.001). Especially all serous and mucinous malignant tumors (n=9) showed weak and strong immunoreactivity, with 66.7% strong reactivity. None of the nonepithelial ovarian tumors expressed COX-2 immunoreactivity. CONCLUSION: These preliminary data indicate that COX-2 may have a role in carcinogenesis of epithelial ovarian tumors, especially in the serous and mucinous types. COX-2 maybe a target for future research in the tumorigenesis of the epithelial ovarian malignancies.

Changing Trends in Surgical Approaches of the Hysterectomy: 3408 cases Vaginal Hysterectomy-The University of Hallym Hospital's Experience in Korea / 대한산부인과학회잡지

OBJECTIVE: The purpose of our study evaluate to assess the feasibility and safety of performing vaginal hysterectomy on our experience. METHODS: Between 1990 year and 1997 year, 3408 women underwent vaginal hysterectomy without laparoscopic assistance at Hallym University Hospital in Korea. All hysterectomies(abdominal & vaginal) were reviewed and these were compared with all hysterectomy cases from most recent year available for complete analysis. RESULT: 1. In 1990 yrs~1997 yrs, vaginal hysterectomies compromised 51%(vaginal hysterectomy [below VH]: 268 / total abdominal hysterectomy [below TAH]: 258; 1990), 55%(VH: 254/TAH: 212; 1991), 60%(VH: 346/TAH: 227; 1992), 64%(VH: 341/TAH: 190; 1993), 72%(VH: 434/TAH: 168; 1994), 75%(VH: 489/TAH: 156; 1995), 76.%(VH: 632/TAH: 196; 1996), 78%(VH: 657/TAH: 190;1997), a high increased rate of vaginal hysterectomy significantly. 2. The average age of patients was 41.9+/- 8.18(26~84) years old and 25 nullipara and 274 primiparas and 3109 multiparas. The mean parity was 2.74+/-0.36. 3. The common surgical indications were uterine myoma(53.9%), prolapse of uteri(23.3%), CIN II-III or microinvasive cervical cancer(6.5%), others(16.3%) 4. The average time of operation(hysterectomy and colporrhaphy) was 78.3+/- 14.2 min(40~230). 5. The average weight of uterus was 166.5+/- 111.4 gm(60~1130 gm), 34.0% was done morcellation. 6. 5.7% of operated women had previous abdominal operaton (without tubal ligation). 7. The common associated procedures were posterior colporrhaphy(47.4%), anteroposterior colporrhaphy(45.6%), adnexectomy(4.9%), other(2.1%). 8. The mean blood loss was 280+/- 104.4 ml and 12.4% of operated women were need of transfusion. 9. The minor complication rate was 10.6% e.g. urinary retention(5.3%-179cases), abdominal bleeding (including conversion TAH) (0.3%-9cases), pelvic hematoma(0.3%-11cases), post operation fever(2.8%-94cases), mortality cases none. 10. The mean hospital days were 7 days(4~20) CONCLUSION: In our experience the following conclusions have been reached that vaginal hysterectomy is usually well tolerated by most women, a safe operation with few complications and without notable blood loss and without the need of expensive laparoscopic equipment. The incidence of vaginal hysterectomy is characterized by pronounced fluctuations suggested that no valid general guidelines have yet been established for the indication via vagina of surgical treatment. The incidence of vaginal hysterectomy correlates with the experience of individual surgeon strongly. Vaginal hysterectomy remains the method of choice for removal of the uterus in the absence of absolute contraindication.

A case of Pelvic Actinomycosis Associated with Intrauterine Device / 대한산부인과학회잡지

Actinomycosis is a chronic, progressive, suppurative disease which appears to be difficult to establish a correct preoperative diagnosis. Most of pelvic actinomycosis in women are related to a long time intrauterine device(IUD) inserted state. The causative agent is a branching, gram-positive anaerobic or microaerobic organism, not fungi. Ascending infection of the upper genital tract by actinomycosis may be clinically inapparent. We experienced a case of clinically inapparent tuboovarian actinomycosis in a 47-year-old women with IUD, discovered pathologically after laparotomy.

Aggressive Angiomyxoma of the Vagina / 대한산부인과학회잡지

Aggressive angiomyxoma is a rare pathological condition which affects mainly the soft tissues of the pelvis and perineum in women. It is circumscribed totally or partially and has a infiltrative margin, so it has a tendency for local recurrence. We report a 33-year-old woman who presented with a mass arising within the vaginal wall which was painless, soft and movable like a cyst on palpation. The mass was surgically excised and pathologically proved to be an aggressive angiomyxoma.

A Study of Interleukin -8 in the Peritoneal Fluid of Patients with Endometriosis / 대한산부인과학회잡지

No abstract available.

Cyclooxygenase - 2 Expression in Cervical Intraepithelial Neoplasia and Cervical Cancer / 대한산부인과학회잡지

OBJECTIVE: A large body of evidence suggests that cyclooxygenase-2(COX-2) is important in tumorigenesis of gastrointestinal cancer. The purpose of this study was to determine whether COX-2 was also expressed in cervical intraepithelial neoplasia(CIN) and invasive cervical carcinoma. METHODS: We studied the expression of COX-2 in normal cervix(n=6), CIN I(n=4), CIN II(n=2), CIN III(n=15), microinvasive carcinoma(n=5) and invasive carcinoma(n=7) by immunohistochemistry. RESULTS: We observed strong COX-2 expression in 16.7% of the normal cervix, 0% of the CIN I and II, 80.0% of CIN III, 60.0% of microinvasive carcinoma and 71.4% of invasive carcinoma. The intensity of immunostaining was stronger in the CIN III and invasive cancer than the normal cervix and CIN I lesions(p<0.01). CONCLUSION: These results suggest that COX-2 may have a role in carcinogenesis of CIN and may be a target for the prevention or treatment of CIN and invasive cervical cancer.

The Diagnosis and Treatment in 46 Cases with Microinvasive Carcinoma of the Cervix Uteri / 대한부인종양콜포스코피학회잡지

OBJECTIVE: To review recurrence and prognosis of microivasive squamous cell carcinoma of the cervix that are associated with depth of invasion, pathologic finding and management(conservative or radical treatment) STUDY DESIGN: We conducted retrospective study in order to evaluate the results of therapeutic approaches in 46 patients with microinvasive cervical cancer from Jan 1987 to Oct 1996. RESULT: The mean age of patients was 44.6+ 8.86 years. Only one woman was nullipara, and the mean parity was 2.8, Overall diagnostic accuracy of pap smear and punch biopsy were 54.3% and 79.4%. As the depth of invasion was deeper, the diagnostic accuracy of punch biopsy increased(p<0.05), The confluence pattern and lymphovascular space involvement were observed in 39.1% and 4.9%. The confluence pattern was observed with statistical significant in advanced depth of stromal invasion. In the surgical management, vaginal hysterectomy was done in 28 patients, conization(l patient), total abdominal hysterectomy(8 patients) and radical hysterectomy with pelvic lymph node dissection(9 patients) was done, no positive node was in 104 pelvic lymph node dissected. Though all cone margin was free and all endocervical curettage was negative, residual lesion(2 patients) was present in the hysterectomy after conization, The median follow-up period was 64 months. There was no recurrence in all cases and 5 years survival rate was 100% CONCLUSION: We suggest that microinvasive carcinoma of the cervix may be the disease of good prognosis and no recurrence, and less radical therapy for the patients with microinvasive carcinoma may be sufficient.

Antenatal Corticosteroid Therapy to Prevent Neonatal Respiratory Distress Syndrome / 대한주산의학회잡지

OBJECTIVES: Our purpose was to determine the efficacy of maternal corticosteroid therapy in the prevention of neonatal respiratory distress syndrome. STUDY DESIGN: The data in this study was taken from 136 women who participated in prematurity prevention programs at two hospital. Of 136 women who were delivered at 25 to 34 weeks, 68 received dexamethasone and 68 did not. 'I'he frequency and relative risk of adverse outcomes, including repiratory distress syndrome, necrotizing enterocolitis, neonatal sepsis and maternal infection wcre compared by means of univariate techniques. RESULT: When dexamethansone was administered, there was a lower incidence of respiratory distress syndrome at between 30 to 32 weeks gestation (relative risk of treatment group vs control group=0.425, p0.05). I'here was no statistical difference between 33 weeks to 34 weeks (relative risk of treatment group vs control group=0.782, p>0.05). 'I'here was no statistical significance in the incidence of maternal infection, neonatal sepsis or necrotizing enterocolitis (p=0.808, p=0.698, p=0.559). CONCLUSION: Dexamethasone appears to significantly reduce neonatal respiratory distress syndrome at between 30 and 32 weeks gestation.