A case of ipsilateral ruptured cornual pregnancy after salpingectomy for tubal pregnancy: 2-port pelviscopic cornual resection using a multichannel port / 대한산부인과내시경학회지

Cornual pregnancy is a rare type of ectopic pregnancy. Its incidence is 2-4% of all tubal pregnancy. Cornual pregnancy is relatively rare in the woman who has the history of ipsilateral salpingectomy. The standard treatment of cornual pregnancy was cornual resection or hysterectomy through laparotomy. Recently, pelviscopic cornual resection has been performed with the advance of technique and instruments. We performed 2-port pelviscopy using a multichannel port in the case of ipsilateral ruptured cornual pregnancy after salpingectomy for tubal pregnancy. This method was relative safe and easy and offers the advantages in reduced surgical morbidity, less bleeding and less operation time. Therefore, we present a case of ipsilateral cornual pregnancy after salpingectomy that surgically treated under 2-port pelviscopy with a brief review of literature.

The effect of pneumoperitoneum and Trendelenburg position on respiratory mechanics during pelviscopic surgery / 대한마취과학회지

BACKGROUND: Conventional pelviscopic surgery requires pneumoperitoneum with CO2 gas insufflation and lithotomy-Trendelenburg position. Pneumoperitoneum and Trendelenburg position may influence intraoperative respiratory mechanics in anesthetic management. This study was conducted to investigate the influence of pneumoperitoneum and Trendelenburg position on respiratory compliance and ventilation pressure. METHODS: Twenty-five patients scheduled for elective gynecologic laparoscopy were evaluated. The patients had no preexisting lung or heart disease or pathologic lung function. Conventional general anesthesia with thiopental sodium, lidocaine, rocuronium, and sevoflurane was administered. The peak inspiratory pressure, plateau pressure, and end-tidal CO2 were measured before and after creation of pneumoperitoneum with an intraabdominal pressure of 12 mmHg, then after 10 minutes and 30 minutes in the 20degrees Trendelenburg position, and after deflation of pneumoperitoneum. The dynamic lung compliance was then calculated. RESULTS: Following creation of pneumoperitoneum, there was a significant increase in peak inspiratory pressure (6 cmH2O), plateau pressure (7 cmH2O), and end-tidal CO2 (5 mmHg), while dynamic lung compliance decreased by 12 ml/cmH2O. Overall, the Trendelenburg position induced no significant hemodynamic or pulmonary changes. CONCLUSIONS: The effects of pneumoperitoneum significantly reduced dynamic lung compliance and increased peak inspiratory and plateau pressures. The Tredelenburg position did not change these parameters.

Differential usefulness of pelviscopy for PID: 4 cases of acute appendicitis / 대한산부인과학회지

The pelvic inflammatory disease (PID) occurs when microbacteria ascend via vagina to the upper genital organs such as endometrium, tubes, ovaries and even pelvic peritoneum as a result of infected intercourse. That could be presented as perihepatitis, parametritis, intraperitoneal pelvic inflammatory disease, not to mention endometritis, salpingitis and tubo-ovarian abscess. Symptoms and signs of PID resembles those of several abdominal diseases such as acute appendicitis, acute gastroenteritis, ectopic pregnancy, and adnexal torsion. Especially differentiation of acute appendicitis from PID is very important because acute appendicitis must be treated by operation but PID could be treated by surgery or antibiotics only even though their symptoms and signs are very alike. So, diagnostic pelviscopy for PID is very important for differential diagnosis and further management. We experienced and report four cases of appendicitis that could not be diagnosed differentially from PID which managed with the emergent pelviscopy successfully.

Differential usefulness of pelviscopy for PID: 4 cases of acute appendicitis / 대한산부인과학회지

The pelvic inflammatory disease (PID) occurs when microbacteria ascend via vagina to the upper genital organs such as endometrium, tubes, ovaries and even pelvic peritoneum as a result of infected intercourse. That could be presented as perihepatitis, parametritis, intraperitoneal pelvic inflammatory disease, not to mention endometritis, salpingitis and tubo-ovarian abscess. Symptoms and signs of PID resembles those of several abdominal diseases such as acute appendicitis, acute gastroenteritis, ectopic pregnancy, and adnexal torsion. Especially differentiation of acute appendicitis from PID is very important because acute appendicitis must be treated by operation but PID could be treated by surgery or antibiotics only even though their symptoms and signs are very alike. So, diagnostic pelviscopy for PID is very important for differential diagnosis and further management. We experienced and report four cases of appendicitis that could not be diagnosed differentially from PID which managed with the emergent pelviscopy successfully.

Prevention and management of complication of pelviscopic operation / 대한산부인과학회지

Since the introduction of laparoscopic surgery in 1950's, pelviscopic surgery has been established as a popularly used surgical modality in many areas due to the wide spread of minimally invasive surgery in 1980's. In spite of its many advantages compared to laparotomy, pelviscopic surgery is accompanied by many complications caused by equipments or anesthesia as various methods have been developed. Common complications include the injury of major and abdominal wall vessels, intestines, bladder and ureter, incisional hernia, heat injury by electricity, gas embolism, shoulder pain, pneumothorax, subcutaneous emphysema, and venous thrombosis. The frequency of complications is known to be 0.2-10.3%, and the half happens during the process of gas insufflation needle or trocar insertion. Order to prevent the complications, the operators should observe the safety regulations and perform the surgical procedures according the detailed operation principles. The patients with contraindications such as intestinal obstruction, hernia, severe cardiovascular diseases or peritonitis and extreme ages, should be avoided. The operators should be prepared for the expected complications by preoperatively evaluating the risk factors such as history of abdominal surgery, obesity, and heart and lung diseases. In addition, they should be well aware of biophysics of instruments, be experienced, and follow the basic safety rules such as the precautions about unnoticeable electrical damage of neighboring tissues.

Pelviscopic Management Of The Chemical Panperitonitis Due To Ruptured Ovarian Endometrioma: Two Cases / 대한산부인과학회지

Rupture of ovarian endometrioma is rarely occurred. It causes chemical panperitonitis resulting in low fertility and requiring differential diagnosis of acute abdomen. So it needs fast and accurate diagnosis. We have experienced two cases of chemical panperitonitis due to ruptured ovarian endometrioma managed by pelviscopy with a brief review of the literature.

Hemodynamic Changes Measured by Esophageal Doppler Monitor during Laparoscopic Cholecystectomy and Gynecologic Pelviscopy / 대한마취과학회지

BACKGROUND: Laparoscopic cholecystectomy and gynecologic pelviscopy need to induce pneumoperitoneum to allow visualization of the operative field, but the former requires a head-up position whereas the latter needs a Lithotomy-Trendelenburg position. The authors observed hemodynamic changes using an esophageal doppler monitor in both cases. METHODS: Eight females planned for laparoscopic cholecystectomy were assigned to Group 1 and 10 females for gynecologic pelviscopy were assigned to Group 2. Thiopental (5 mg/kg) and vecuronium (0.1 mg/kg) were used to induce general anesthesia. 50% O2-N2O and 1.5 vol.% isoflurane were used to maintain anesthesia. Mechanical ventilation was used with a tidal volume of 10 ml/kg and a respiratory rate of 12 breaths per minute. Mean arterial pressure, heart rate, end-tidal CO2 and peak airway pressure were measured and cardiac output, corrected flow time, and peak velocity were monitored using an esophageal doppler monitor in each group after inducing anesthesia, CO2 inflation, position change, and CO2 deflation. RESULTS: Mean arterial pressure increased in each group while changing position. No significant changes in the heart rate were observed in each group. End-tidal CO2 increased in each group after changing position, and remained elevated even with position reversal and deflation. Peak airway pressure was elevated in each group after CO2 inflation and increased more so with changing posture in group 2 (post inflation: 18.5 +/- 1.4 cmH2O, after position change: 21.4 +/- 2.0 cmH2O). Cardiac output and cardiac index were reduced after the induction of pneumoperitoneum in each group, and reduced more on changing posture in group 2 (CO: 5.9 +/- 2.0 L/min vs. 4.4 +/- 1.5 L/min, CI: 3.7 +/- 1.4 L/min/m2 vs. 2.7 +/- 1.1 L/min/m2). Stroke volume also reduced after changing posture in each group. Corrected flow time was not changed, but peak velocity decreased after CO2 inflation in each group (group 1: 97.4 +/- 30.0 cm/s vs. 78.9 +/- 27.3 cm/s, group 2: 111.9 +/- 14.1 cm/s vs. 88.3 +/- 12.6 cm/s). CONCLUSIONS: The Lithotomy-Trendelenburg position can augment the hemodynamic changes resulting from pneumoperitoneum. Therefore, additional caution is required in patients with cardiovascular disease who are undergoing gynecologic pelviscopy.

A Case of Pelviscopic Surgery for Huge Endometrioma / 대한산부인과학회잡지

A case of huge endometrioma at right ovary in 31-year old woman treated with pelviscopic surgery is presented with a brief review of literature. This tumor was measured 15 X 15 X 16 cm and its content amount was about 1800 cc. The pathologic diagnosis was endometrioma of right ovary.

Prophylactic Antiemetic Efficacy of Ondansetron in Gynecologic Pelviscopic Patients / 대한마취과학회지

BACKGROUND: The safety and efficacy of ondansetron were evaluated for the prophylaxis of postoperative nausea and vomiting (PONV) after pelviscopic gynecologic procedure. We compared the effects of three doses of intravenous ondansetron, 1 mg, 4 mg, and 8 mg. METHODS: Eighty women were randomly allocated to one of 4 groups receiving 1 mg (group 1, n = 20), 4 mg (group 2, n = 20), 8 mg (group 3, n = 20) or normal saline (group 4, n = 20) at the end of pelviscopic operation. PONV were measured using a 4 point scale (0: none, 1: mild, 2: moderate, 3: severe) 1 hr, 2 hr, 6 hr, 12 hr, 24 hr after the operation and other side effects were checked. RESULTS: Over the 24 hr study period, group 2 and 3 showed a significant lower incidence of nausea (15%, 10%) and vomiting (5%, 5%) than in group 1 (nausea: 25%, vomiting: 5%) or group 4 (nausea: 40%, vomiting: 30%). Complete response rates of each group were 80%, 90%, 90% and 50% during first 2 hrs and 50%, 80%, 75% and 30% after 2 hrs after operation. Adverse events were minor, and ondansetron treated patients had profiles similar to those of the placebo. CONCLUSIONS: We concluded that ondansetron at 4 mg or 8 mg is a safe and effective prophylactic antiemetic for women requiring gynecologic pelviscopic surgery under general anesthesia.

Current Status and Clinical Analysis of Gynecological Pelviscopy in Korea / 대한산부인과학회잡지

OBJECTIVE: To evaluate the current status and new trends in gynelcological pelviscopy in Korea. METHODS: A survey was conducted and analyzed based on 20997 cases of operative pelviscopy hom May, 1985 to February, 1998 reported from twenty four university hospitals in Korea. RESULTS: The results obtained were ss followings; 1) 45.9 % of the total cases was 30 to 39 years old age group and it was the most dominant age group, 2) The previous operative history was found in 10.9% of the tota1 cases and included cesarean section(30.0%), ectopic pregnancy(20.3%), etc. 3) The operative indications were diagnostic(26.2%), myoma uteri(23.1%), ectopic pregnancy(21.4%), adnexal mass(18.4%), etc. In cases of diagnostic indication, the most common post-operative diagnosis of pelviscopic surgery was tubal pregnancy(30,6%). 4) The operative titles were salpingectomy(25.1%), hysterectomy(19.9%), salpinghorectomy(19.8%), etc. 5) The complications of operative pelviscopy were composed of subcutaneous emphysema(0.58%), preperitoneal bleeding(0.3%), bladder injury(0,3%), bowel injury(0.3%), etc. 6) lhe survey showed that 57.1% of the respondents desired more than 1 year of period for well peration between the operator and the assistant. 56.7% of respondents indicated that the surgical technique of the operator was the most important factor for a successful pelvisocopic surgery. 7) The most beneficial effect of the pelviscopy included the comfortableness of the patient(40.0%), cosmetic effect(22.8%), decrease of complications(14.2%), etc. CONCLUSION: The modem methods of operative pelviscopy have been successfully used in the treatment of gynecological disease. Today, pelviscopic surgery is being applied in almost all the cases of gynecological disease. Hence, the majority of pelviscopy techniques and pracedures being performed by surgeon must be taught in the controlled setting of a residency or a fellowship training program.

The Effect of the Body Position and CO2 Gas Insufflation on Airway Pressure and Compliance in Normal Subjects during Laparoscopy or Pelviscopy / 대한마취과학회지

BACKGROUND: Laparoscopic and pelviscopic techniques have rapidly increased in recent years. Laparoscopy or pelviscopy require carbon dioxide (CO2) insufflation and Trendelenburg or reverse-Trendelenburg position for operational convenience. Many studies were done about the effects of laparoscopic procedures. But simultaneous comparisons of end-tidal CO2 tension (PETCO2), peak airway pressure (Ppeak), plateau pressure (Pplat) and respiratory compliance (Cdyn), between Trendelenburg and reverse-Trendelenburg position are rare. We compared the airway pressure and compliance between the two positions during laparoscopic surgery. METHOD: Eighty patients were divided into 2 groups: for 10o reverse-Trendelenburg position (n=40, Group R) and 10o Trendelenburg position (n=40, Group T). Abdominal pressure was maintained at 10 mmHg by a CO2 insufflator, and minute ventilation was controlled with a constant tidal volume and fixed respiratory rate. We observed the change of PETCO2, Ppeak, Pplat, and Cdyn at 1 minutes before CO2 insufflation (control value), 2 min after position change, 5, 20, 30, 60 minutes after CO2 insufflation, 2 min after CO2 removal, and 2 min after operation. RESULT: PETCO2, Ppeak, and Pplat were increased and Cdyn was decreased significantly after pneumoperitoneum compared with the control in group R. PETCO2, Ppeak, and Pplat were increased significantly under the Trendelenburg compared with the reverse-Trendelenburg, and Cdyn was decreased significantly in Trendelenburg compared with reverse-Trendelenburg. CONCLUSION: PETCO2, Ppeak, Pplat, and Cdyn impedances increased more under the Trendelenburg after pneumoperitoneum compared with reverse-Trendelenburg. We should pay more attention to patient with pulmonary disease, obesity, and old age under the Trendelenburg than reverse-Trendelenburg position.

Pelviscopic Gonadectomy in two cases of Complete Androgen Insensitivity Syndrome / 대한산부인과학회잡지

Androgen insensitivity syndrome is a genetic syndrome characterized by complete or partial resistance of end organs to the peripheral effect of androgen. The phenotype of this condition is female, despite the normal male karyotype 46,XY. This is the third most common cause of primary amenorrhea after gonadal dysgenesis and mullerian agenesis. There is a congenital insensitivity to androgens, transmitted by means of a maternal X-linked recessive gene responsible for the androgen intracellular receptor. Prophylactic gonadectomy in usually performed due to increased risk for development of malignancy and possible virilization. Pelviscopy provides a minimally invasive technique for the accurate diagnosis and also provides the opportunity for therapeutic management of these patients. Recently we experienced two cases of this syndrome and removed the gonad by pelviscopic surgery, so we presented them with brief review of literature.

Effects of Pelviscopy on the PaCO2 and Hemodynamics / 대한마취과학회지

BACKGROUND: Pelviscopy has become popular because of the advantage of which less painful, less scarring, and shortening the hospitalizing stays, so to reduce the cost. This procedure require lithotomy- Trendelenburg position and pneumoperitoneum with carbon dioxide(CO2) gas insufflation, that affect arterial blood gas and hemodynamics. We studied the effects of pelviscopy on the PaCO2 and hemodynamics. METHODS: Twenty patients scheduled for pelviscopic hysterectomy were studied. All patients anesthetized with enflurane (2.0 vol%) - nitrous oxide (1.5 L/min) and oxygen (1.5 L/min), and controlled ventilation(tidal volume 10 ml/kg, respiratory rate 12 /min). Central venous pressure, blood pressure, heart rate and PaCO2 measured at postinduction(control), position change with CO2 gas insufflation, and every 15 minutes after pneumoperitoneum. RESULTS: Central venous pressure increased (P<0.05) through the procedure after position change and CO2 gas insufflation. Systolic blood pressure and heart rate decreased at 45min after pneumoperitoneum(P<0.05). Mean arterial pressure decreased at 75 min after pneumoperitoneum. PaCO2 increased at 15 min after position change and pneumoperitoneum(P<0.05). CONCLUSION: In our study, because central venous pressure and PaCO2 increased, we should attend to patients with hypertension, increased intracranial pressure, and increased PaCO2.

The Effects of Trendelenburg Position and Intraabdominal CO2 Gas Insufflation on Cardiopulmonary System during Pelviscopic Surgery under General Anesthesia / 대한마취과학회지

BACKGROUND: Pelviscopic techniques have rapidly increased in therapeutic procedures as well as diagnostic procedures because of the many benefits associated with much smaller incisions than traditional open techniques. But the deliberate pneumoperitoneum with carbon dioxide during pelviscopic surgery may cause some problems-hypercarbia, pneumomentum, subcutaneous or mediastinal emphysema, pneumothorax, hypoxemia, hypotension, cardiovascular collapse and cardiac dysrhythmia. METHOD: We observed the changes of blood pressure (systolic, mean, diastolic), pulse rate, PaCO2, PaO2, peak inspiratory airway pressure and expired tidal volume at 10 minute after induction of general anesthesia (control value), 30 minutes and 60 minutes after insufflation of CO2 and Trendelenburg position. RESULTS: The blood pressure, PaCO2 and peak inspiratory airway pressure were increased significantly than control values (p<0.05). The changes of pulse rate and expired tidal volume were not statistically significant in comparison to control values. The PaO2 was decreased significantly (p<0.05). CONCLUSION: To minimize the risk of CO2 retension and unstability of cardiovascular system during pelviscopy under the Trendelenburg position, we must monitor the vital signs and the arterial blood gas status continuously and carefully.

A Case of Dysgerminoma Incidentally Found after Pelviscopic Ovarian Surgery / 대한산부인과학회잡지

No abstract available.

The Current Trend in the Diagnosis and Management of Ectopic Pregnancy / 대한산부인과학회잡지

This retrospective study was undertaken to investigate the current clinical trend in the management of ectopic pregnancy. 562 patients of ectopic pregnancy were admitted and managed at the Department of Obstetrics and Gynecology, Chonbuk National University Hospital from Jan. 1. 1985 to Dec. 31. 1996. All cases had a reliable medical record and were divided into two groups, of which group A includes patients admitted from Jan. 1. 1985 to Dec. 31. 1990, group B from the Jan. 1. 1991 to Dec. 31. 1996. The results were obtained as follows. 1. The number of cases of ectopic pregnancy were 248 in group A and 314 in group B. 2. The age group of 20 to 29 years of age was top ranked in group A(49.6%) as well as in group B(46.8%). The age group of 30 to 39 years was 43.2% in group A and 46.6% in group B, respectively. 3. In group A, the case who experienced two deliveries was 31.9%, and nulliparous woman was 30.6%. In group B, the case who experienced two deliveries was 33.1%, nulliparous woman was 33.1%. 4. On reviewing the past medical history, ectopic pregnancy was 11.2% in group A, 10.8% in group B, respectively. Pelvic inflammatory disease was 8.1% in group A and 11.0% in group B, respectively. 5. The interval between the last menstrual period and the onset of symptoms was prevalently in 4 to 8 weeks(64.5% in group A, 61.8% in group B). The terval of 12 weeks or more was 2.0% in group A and 6.0% in group B, respectively. 6. In considering the chief complaints, low abdominal pain was 85.9% and vaginal spotting was 69.0% in group A. On the other hand, low abdominal pain was 91.4% and vaginal spotting was 76.4% in group B, meanwhile nausea and vomitting was 8.6% and dizziness was 3.5% in group A, there were 23.4% of nausea and vomitting and 9.7% of dizziness in group B,7. In relation of the diagnostic methods, the positive rate of culdocentesis in group B was lower than the rate in group A. Diagnostic laparoscopy was done in 5.6% of group A and 14% of group B. The detection rate of adnexal mass and fluid collection in the pelvic cavity was higher in group B than in group A on the ultrasonographic examination. 8. Initial hemoglobin value of 10.1mg/dl or more was 70.9% in group A and 73.2% in group B. The value of 8.0gm/dl or less was 6.4% in group A and 7.0% of group B, respectively. Initial systolic pressure of 110mmHg or more was 74.6% in group A and 66.6% in group B. The systolic pressure of 90mmHg or less was 3.6% in group A and 8.3% in group B.9. The conceptus was almost implantd in the fallopian tube. The ampullary portion was the most common site of ectopic implantation in both groups. 10. Intraabdominal hemorrhage of 500ml or less in amount was 52.4% in group A and 61.1% in group B, individually. However transfusion was not given in 55.6% of group A and in 71.0% of group B. 11. In the therapeutic modalities, laparotomy was performed in 96.8% of group A and in 82.8% of group B, respectively. The pelviscopic operation was done in 2.4% of group A and in 22.3% of group B. In conclusion, ectopic pregnancy was diagnosed increasingly prior to the onset of the hypovolemic symptoms according to developement of high-resolution ultrasonogram, diagnostic laparoscopy and beta-hCG test, therefore the use of minimally invasive techniques in the management of ectopic pregnancy was increasing.