Laparoscopic surgery for pelvic floor disorder / 한양의대학술지

Pelvic organ prolapse(POP) is a major health care problem. Up to 50% of parous women have some degree of pelvic organ prolapse although only 10?20% are symptomatic. The first line of treatment is surgical repair. Many surgical procedures have been described to correct pelvic organ prolapse. The majority of these procedures are performed either vaginally or abdominally, or with a combined abdominovaginal approach. With recent advancements of laparoscopic instruments and surgical techniques, interest in laparoscopic treatment of pelvic organ prolepse has surged. Beyond the well-known advantages of laparoscopy - less postoperative discomfort, shorter hospital stay, the laparoscopic approach offers the superior visualization of the pelvis, thereby allowing better exposure of the pelvic floor anatomy and more exact identification of the defect. Moreover, laparoscopic surgery provides a magnified view of the operative field and enables to perform an easier and more precise dissection. This enhances the identification of pelvic floor defects and allows more precise suture placement and improved correction of specific site defects. Laparoscopic pelvic floor repair is an effective procedure and enables to combine the advantages of laparotomy with the low morbidity of the vaginal route. This article reviews pelvic support anatomy and various laparoscopic surgical techniques currently available for reconstructive pelvic surgery.

A retrospective comparison of four different procedures for extracting dermoid cyst by laparoscopy / 대한산부인과학회잡지

OBJECTIVES: To compare results of 4 different extraction methods in laparoscopic management of dermoid cyst. STUDY DESIGN: This article is a retrospective, multicenter study for 247 patients with benign dermoid cyst in period of 1995-1998. Dermoid cyst was extracted by Endopouch (99 cases), puncture-irrigation-extraction (69 cases), colpotomy (35 cases), and dermoid cyst as a "pouch bag" (44 cases). RESULTS: We analyzed irrigation amount, operative time, postoperative hospital stay and complications by four different extraction methods. Endopouch extraction method needed less amount of irrigation fluid for cleaning the abdominal cavity and had a shorter postoperative hospital stay (ANOVA, p=0.0001). There were no significant differences in operative times among groups. There were four cases of morbidity in puncture-irrigation-extraction method (6%), three had fever (> 38degrees C) and one intraabdominal abscess. One incisional hernia was noted in "pouch bag" method (2%). CONCLUSIONS: We recommend minimal spillage method for extraction of dermoid and careful irrigation of abdominal cavity to prevent potential risk of chemical peritonitis such as Endopouch, "pouch bag", and colpotomy with the exception of puncture-irrigation-extraction method.