Emergency cervical cerclage in advanced cervical incompetence / 대한산부인과학회지

OBJECTIVE: To investigate the clinical effectiveness of emergency cervical cerclage in pregnant women with advanced cervical incompetence in the second trimester. METHODS: This study analyzed retrospectively the pregnancy outcomes of 20 patients who were offered emergency cerclage between June 2000 and April 2004. Group I was defined as the patients cervical dilatation without membrane prolapse. Group II was the patients with membrane prolapse into vagina, who were underwent amniocentesis to decrease intraamniotic pressure. RESULTS: The mean+/-SD gestational age at cerclage was 21.6+/-2.4 weeks (Group I: 21.0+/-2.5, Group II: 22.1+/-2.3). The mean cervical dilatation was 2.5+/-0.9 cm (Group I: 1.8+/-0.5, Group II: 3.2+/-0.8) and mean effacement was 79.0+/-12.9% (Group I: 68.8+/-11.6, Group II: 87.3+/-6.4). The mean interval from cerclage to delivery was 9.4+/-5.3 weeks (Group I: 11.1+/-6.1, Group II: 7.9+/-3.7) and mean gestational age at delivery was 31.0+/-6.0 weeks (Group I: 32.2+/-7.4, Group II: 30.0+/-4.9). The birth weight was 1.9+/-1.1 kg (Group I: 2.4+/-1.4, Group II: 1.6+/-0.8) and the perinatal survival rate was 75% (Group I: 77%, Group II: 73%). Cervix dilatation and effacement were significantly more advanced in group II compared to the group I (p<0.05). However, the duration of pregnancy prolongation and birth weight, gestational age at the delivery were not significantly different between both groups. CONCLUSION: This results suggest that emergency cervical cerclage might be an effective treatment in advanced cervical incompetence, and that the concomitant amniocentesis could help the cerclage in the patients with membrane prolapse.

The efficacy and feasibility of the laparoscopy assisted mini-lap myomectomy (LAMM) of huge myoma / 대한산부인과학회지

OBJECTIVE: To evaluate the effectiveness and feasibility of the laparoscopy assisted mini-lap myomectomy (LAMM) as an alternative to laparotomy for patients with multiple or huge myoma unsuitable for laparoscopic myomectomy. METHODS: Uncontrolled retrospective study was done on the forty-six women with myoma of 16 or more gestational sized who were undertaken laparoscopy assisted mini-lap myomectomy. The operative procedures consisted of: 1) examination of pelvic cavity, 2) infiltration of diluted vasopressin, 3) enucleation of myoma, 4) suture of uterus, and 5) removal of myoma. The examination of pelvic cavity was always done using laparoscopy. Either the laparoscopic or mini-lap method for each of the remaining steps was determined depending on the characteristics of the cases. Before operation, patients with severe anemia were corrected by the administration of oral or parenteral iron. RESULTS: The mean age of the patients was 33.3 +/- 4.7 years, their mean gravidities and parities were 0.74 and 0.24, respectively. Of 46 patients, 28 women were married and 20 desired childbearing. The mean (+/-SD) myoma weight was 501 +/- 353 (range 130-1600) gm. The mean operation time was 87.0 +/- 31.3 minutes and blood loss was 208 +/- 239 mL. The mean incision length of mini- lap was 4.6 +/- 1.1 (range 2.5-6) cm. Postoperatively, 1 case of wound abscess occurred. Postoperative mild anemia was correctable with oral iron. Most patients were resumed normal activity within 3 weeks. The mean period of follow-up was 20 (range 6-58) months. Of 20 who desired childbearing, 15 women were follow-up and 9 women conceived. In 6 patients who underwent cesarean section, no significant adhesion or defect was found in the uterus. CONCLUSION: These results suggest that LAMM is feasible and safe minimal invasive method that could replace routine laparotomy in patients with huge myoma.

Successful endoscopic operations in benign gynecologic diseases: experiences of 6,017 cases / 대한산부인과학회지

OBJECTIVE: The purpose of this study is to evaluate the application rate and effectiveness of endoscopic operations based on 6,017 cases in the field of gynecology. METHODS: Six-thousand-seventeen cases of endoscopic operations were performed from March 1993 to June 2004 in the department of Obstetrics and Gynecology, Center for Endoscopy, Good Moonhwa Hospital. Endoscopic operations were done on the majority of patients who had benign gynecologic diseases. We applied "two-surgeons system" and simplified methods of operation consisted of endoloop-ligation, endosuture and endotying. RESULTS: Our endoscopic operations were successful in 5,994 cases (99.62%) out of 6,017 attempts. Twenty-three cases (0.38%) were converted to laparotomy due to severe pelvic adhesion, excessive bleeding or difficulty in accessibility. In the first year endoscopic operations were done in 29.0% of the total gynecologic operations, but was increased to 52.9% during the next 4 years. In 2003, 93.0% and in 2004, 99.0% of the total gynecologic operations were done by endoscope. While the simple technique surgeries showed a high application rate, the more complicated technique surgeries, which began at a lower rate, showed a steady increase up to 89.3%. Blood loss and operation time were markedly declined during 3 year period and maintained at a low level thereafter. A 3 years' period of endoscopic operations (about 500 cases) is necessary for a hospital learning curve while, 26.4 cases is necessary an individual surgeon's learning curve. The major complications during the study period was 28 cases (0.47%). CONCLUSION: Endoscopic operations can be applied in almost all benign gynecologic diseases. In particular, "two-surgeons system" is a safe method with few complications and minimal learning period. These results suggest that if appropriate techniques could be learned, endoscopic operation might be preferred to laparotomy for both surgeons and patients.

Learning Curve of Laparoscopic Myomectomy / 대한산부인과학회잡지

OBJECTIVE: To evaluate the effectiveness and feasibility of laparoscopic myomectomy compared to open myomectomy METHODS: A retrospective study of 85 cases of myomectomy was performed. Twenty six cases of open myomectomy (group I) and 59 cases of laparoscopic myomectomy (group II) were done by one main surgeon from 1996 to 2002 in the department of OBGYN at Moonhwa Hospital. Group II was divided into two subgroups, group IIA and group IIB. Group IIA included 17 cases of laparoscopic myomectomy done from 1996 to 1998 during learning period. Group IIB included 42 cases of laparoscopic myomectomy performed from 1999 to 2002 after learning period. RESULTS: There were no significant differences in age, parity, the number of myoma, and the size of myoma between groups I and II. The intensity of postoperative pain and febrile morbidity were significantly lower in group II than in group I (P<0.05). Mean operation time was significantly shorter in group I than in group II. However, after completing the learning curve, no significant difference was found in the operation time between group I and group IIB. Blood loss was significantly decreased in group II compared to group I (P<0.05). CONCLUSION: The learning curve for lasparoscopic myomectomy needed 17 cases and laparoscopic myomectomy could be an excellent minimally invasive method as an alternative of open myomectomy after learning curve.

Successful correction of posthysterectomy vaginal vault prolapse by repair of fascial defects and by using uterosacral ligament suspension / 대한산부인과학회잡지

OBJECTIVE: To report the method and efficacy of the site specific-defects repair in the endopelvic fascia and uterosacral ligament suspension for the correction of posthysterectomy vaginal vault prolapse. METHODS: This study was performed in 3 patients with posthyterectomy vaginal vault prolapse who underwent the surgery for the reconstruction of endopelvic fascia and the correction of vault prolapsed vagina by using uterosacral ligament suspension at the department of Obstetrics and Gynecology in Moon-Hwa Hospital. Among them, 1 patient was treated by laparotomy, and 2 patients were treated by laparoscope. RESULTS: The age of patients ranged from 49 to 67 years. The mean operation time was 111 minutes (105-120 minutes). The status of postoperative vagina was normal in all 3 patients, who were discharged 9 days after operation without symptoms. No complication or recurrence were found in them despite long-term follow-up for 24 months, 12 months, 7 months, respectively after operation. One patient has been treated with HRT therapy. CONCLUSION: The reconstruction of the defect of endopelvic fascia and uterosacral ligament fixation may be very safe, effective, and functional in the correction of vaginal vault prolapse. This study reports the treatment of vaginal vault prolapse using uterosacral ligament within Korea for the first time.