Total laparoscopic hysterectomy via suture and ligation technique

OBJECTIVE: The term 'total laparoscopic hysterectomy (TLH) with classical suture method' refers to a surgical procedure performed using only sutures and ligations with intracorporeal or extracorporeal ties, without using any laser or electronic cauterization devices during laparoscopic surgery as in total abdominal hysterectomy. However, the method is not as widely used as electric coagulation equipment for TLH because further advances in technology and surgical technique are required and operative time can take longer. In the current study, we evaluated the benefits of the classical suture method for TLH. METHODS: This study retrospectively reviewed patients who received TLH using the classical suture method from August 2005 to April 2014. The patients' baseline characteristics were analyzed, including age, parity, cause of operation, medical and surgical history. Surgical outcomes analyzed included the weight of the uterus, operative time, complications, changes in hemoglobin level, blood transfusion requirements, and postoperative hospital stay. RESULTS: Of 746 patients who underwent TLH with the classical suture method, mean operation time was 96.9 minutes. Mean average decline in hemoglobin was 1.6 g/dL and transfusion rate was 6.2%. Urinary tract injuries were reported in 8 patients. Urinary tract injuries comprised 6 cases of bladder injury and 3 cases of ureter injury. There were no cases of vaginal stump infection, hematoma, bowel injury or abdominal wound complication. All cases involving complications occurred before 2010. CONCLUSION: The classical suture method for TLH presents tolerable levels of complications and blood loss. Advanced surgical skill is expected to decrease operation time and complications.

Integrated Care Center for High Risk Pregnancy and Neonate: An Analysis of Process and Problems in Obstetrics / 대한주산의학회잡지

The medical environment of obstetric field has been deteriorated seriously, which is caused by sharply declined birth rates and several other causes in Korea. Inversely, the prevalence of high risk pregnancy is continuously going to explode, and human resources and facilities in delivery unit are still in shortage. It is greatly needed to be reinforced, but rather diminished substantively. Finally, maternal death rate of Korea has been extremely increased. It is time that the policies for treatment of high risk maternity in national level, no more leave the situation unchanged. The integrated care system which treats high risk maternity and neonate sequentially is very important in their disease characteristics. It is sure that the integrated management of high risk pregnancy and neonate can make an important role in the improvement of perinatal and maternal death rate and maternal-neonatal health care. Therefore, Ministry of Health and Welfare made a policy that establishes 'Integrated Care Center for High Risk Pregnancy and Neonate' for high risk maternity and neonate. It is supposed to start from four centers as a demonstration project in 2014, and will finally establish 17 centers in 11 broad territories of the country in 2017. It will accomplish a task of emergency center, and carry out treatment and emergency operation at all times. In addition, it will take the roll of emergency transfer system, data collection and analysis, and preventive management service through public education and relations. In the future, Integrated Care Center will play an important role in improving maternal health care as well as obstetric infrastructure.

The predictive efficacy of maternal serum CA125 in intrauterine early pregnancy with vaginal bleeding / 대한산부인과학회지

OBJECTIVE: To investigate whether sudden rise or already increased level of maternal serum CA125 predicts spontaneous abortion in early pregnancy with vaginal bleeding. And if so, to decide the CA125 cut-off level for poor pregnancy outcomes. METHODS: The prospective study was performed in forty women presenting with any vaginal bleeding at early pregnancy. Maternal serum CA125 levels were evaluated on the first visit and followed up during the first trimester, or until the time to diagnose abortion. Serial maternal serum beta-hCG and ultrasonographic evaluation were also performed at the same time. RESULTS: There were eventually fourteen abortions and twenty-six ongoing pregnancies. Using receiver-operating characteristic curve, 150 U/mL of serum CA125 was the most useful value for predicting spontaneous abortion. In most of abortion women, the serum CA125 level was increased over than 150 U/mL immediately before the abortion. The twelve of 17 women who were 150 U/mL or more resulted in abortion, while there were just two cases of abortion among 23 women who were less than 150 U/mL. Its positive predictive value was 70.6% and negative predictive value was 91.3% respectively (P<0.01). CONCLUSION: There was a strong correlation between high level of serum CA125 and subsequent spontaneous abortion in early pregnancy. It should be valuable to check maternal serum CA125 added to beta-hCG and ultrasound for predicting pregnancy outcome at the early pregnancy, especially in the cases with vaginal bleeding.

Endocervicosis presenting as abdominal wall mass / 대한산부인과학회지

Endocervicosis refers to the presence of benign mucinous glands of endocervical type in ectopic site. It is rare and usually detected incidentally by histologic examination. The urinary bladder is the most common site, but peritoneum, small bowel, abdominal scar, outer wall of the cervix, vagina, and lymph nodes have been documented. Because this is the first documented report of endocervicosis arising in the rectus muscle in korea, we report this with a brief review of the concerned literatures.

Trophoblast Apoptosis and BRCA1 Expression in Fetal Growth Restriction Pregnancy / 대한산부인과학회지

OBJECTIVE: To know the role of trophoblast apoptosis and BRCA1 on pregnancy of intra-uterine fetal growth restriction (FGR). BRCA1 is regarded as not only a tumor suppressor gene but regulator of cell growth, proliferation and differentiation. We tested the hypothesis that enhanced trophoblast apoptosis and expression of BRCA1 reduced placental mass, which caused placental dysfunction and FGR. METHODS: Placentas were obtained from women with pregnancies complicated by FGR (n=10) and from women with controlled normal pregnancies at different gestational ages (n=15). After placental sections were isolated, In Situ DNA 3'-end labelling analysis as well as detection of cytokeratin 18 cleavage products for apoptosis were measured by terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labeling (TUNEL) assay and counter staining with hematoxylin and eosin. The same sections were examined by means of immunohistochemistry and Western immunoblotting for identifying the expression of BRCA1 protein. RESULTS: TUNEL staining exhibited consistently higher levels of nuclear staining and more cytokeratin 18 cleavage products in trophoblasts from FGR than normal growth pregnancy. In the trophoblasts of FGR, the BRCA1 expression and the staining intensity were more augmented on Western blotting and immunohistochemistry than normal pregnancies. There was no remarkable difference of BRCA1 expression according to gestational ages. CONCLUSION: The expression of BRCA1 and apoptosis is up-regulated in human placental villi from pregnancies complicated by FGR. It suggests that BRCA1 may play a role in trophoblast proliferation and differentiation and be related to the pathophysiologic mechanism of FGR. We speculated that the clinical conditions associated with enhanced BRCA1-mediated apoptosis in trophoblasts and thereby contribute to placental dysfunction and FGR.

A Case of Term Delivery in Heterotopic Pregnancy / 대한산부인과학회잡지

Heterotopic pregnancy is that intrauterine pregnancy is accompanied by a coexisting ectopic pregnancy. The incidence of this disease was very rare, but it has been increased considerably with increasing cases of assisted reproductive technologies and tubal injuries resulted from tubal surgery, endometriosis, and PID. These are prerequisites for diagnosis that close monitoring of early pregnancy including serial serum hCG level and transvaginal sonography. We experienced a case of term delivery in heterotopic pregnancy following natural conception, so report this case with brief review of literatures.

A Case of Juvenile Granulosa Cell Tumor / 대한산부인과학회잡지

Granulosa cell tumors costitute 1% to 2% of all ovarian tumors and occur mostly in adult women. Juvenile granulosa cell tumor (JGCT) differs from the adult type in clinical and pathologic features as well as biological behavior. Usually associated with estrogen production, the tumor leads to endocrinologic symptoms such as isosexual precocity in premenarcheal girl and menstrual irregularities or amenorrhea in postpubertal woman. JGCT is diagnosed in early stage with favorable prognosis in most cases while in more advanced stage with grave outcome. The clinical stage at the time of diagnosis is considered the most important prognostic factor. If fertility is desired in the absence of contralateral or pelvic involvement, unilateral salpingo- oophorectomy is justifiable. We experienced a case of JGCT in 22 years old woman who presented with amenorrhea and low abdominal pain, and report this case with a brief review of literatures.