Jeong Min Eom

Does Single-Port Laparoscopic Surgery Reduce Postoperative Pain in Women with Benign Gynecologic Disease?

BACKGROUND Reduced postoperative pain, one of the potential benefits of single-port laparoscopic surgery (SP-LS), has clinically significant importance. The objectives of this study are to compare postoperative pain between SP-LS and conventional laparoscopic surgery (conventional-LS) and to evaluate the difference in postoperative pain between the SP-LS group and the conventional-LS group based on whether a hysterectomy was performed. SUBJECTS AND METHODS We performed a prospective case-control study among women who underwent SP-LS (n=116) and conventional-LS (n=283) for benign gynecologic disease. We evaluated postoperative pain with a visual analog scale for pain score and the requirement for additional analgesics at 2, 4, 6, 12, 24, 48, and 72 hours after surgery. RESULTS The pain score was significantly lower in the SP-LS group compared with the conventional-LS group only at 2 hours after surgery (5.70 ± 2.33 compared with 6.38 ± 2.13, P=.005). However, at all assessment times (2, 4, 6, 12, 24, 48, and 72 hours) after surgery including a hysterectomy (n=188) and all assessment times except 2 hours after surgery that did not include a hysterectomy (n=211), there were no differences in pain score when comparing the SP-LS or conventional-LS groups. CONCLUSIONS Single-port laparoscopy had no effect on postoperative pain except in the immediate postoperative state (2 hours following surgery) in women who underwent surgery that did not include a hysterectomy.

Can laparoscopic radical hysterectomy be a standard surgical modality in stage IA2-IIA cervical cancer?

OBJECTIVES To determine if laparoscopic radical hysterectomy (LRH) can be substituted for radical abdominal hysterectomy for women with International Federation of Gynecology and Obstetrics (FIGO) stage IA2-IIA cervical cancer. METHODS We retrospectively reviewed the medical records of cervical cancer patients who underwent LRH with laparoscopic pelvic lymphadenectomy (LPL) and/or laparoscopic para-aortic lymphadenectomy (LPAL) from March 2003 to December 2011. RESULTS Of 118 enrolled patients, six were in FIGO stage IA2, 66 were in IB1, 41 were in IB2, one was in IIA1, and four were in IIA2. The median operating time, perioperative hemoglobin change, the number of harvested pelvic and para-aortic lymph nodes were 270 min (range, 120-495), 1.7 g/dL (range, 0.1-5), 26 (range, 9-55), and 7 (range, 1-39), respectively. There was no unplanned conversion to laparotomy. Intra- and postoperative complications occurred in 16 (13.5%) and 8 (6.7%) patients, respectively. In a median follow-up of 31 months (range, 1-89), 5-year recurrence-free and overall survival rates were 90% and 89%, respectively. Univariate analysis showed that cervical stromal invasion (P=0.023) and lymph node metastasis (P=0.018) affected survival rate. Cox-proportional hazards regression analysis showed that lymph node metastasis was the only independent factor for poor prognosis (hazard ratio=7.0, P=0.022). CONCLUSIONS LRH with LPL and/or LPAL in women with stage IA2-IIA cervical cancer is safe and feasible in terms of survival and morbidity. Our data suggest the need for larger prospective trials which could support this approach as a new standard of care for stage IA2-IIA cervical cancer.

Surgical and obstetric outcomes of laparoscopic management for women with heterotopic pregnancy

The aim of this study was to investigate the obstetric outcomes and clinical efficacy of laparoscopic surgery for women with heterotopic pregnancy.

Prospective comparison of single port versus conventional laparoscopic surgery for ectopic pregnancy

To investigate the feasibility and safety of single port laparoscopic surgery (SP‐LS) for ectopic pregnancy, irrespective of type of ectopic pregnancy and hemodynamic stability.

Single-port laparoscopic appendectomy during pregnancy.

As a result of the increased demand for minimally invasive surgery, single-port laparoscopic surgery performed via a single incision was introduced and has been performed in various fields. Herein, we report our initial experience with single-port laparoscopic appendectomy (SP-LA) using Gelport access for the treatment of acute appendicitis in 2 pregnant women. SP-LA using Gelport access was performed successfully in these pregnant women without prolongation of operation time, and there was no need for ancillary trocar insertions or conversion to conventional laparoscopy. One woman spontaneously delivered at 39 weeks’ gestation approximately 20 weeks after the surgery and the other has maintained a healthy pregnancy. SP-LA can be considered a minimally invasive alternative to conventional laparoscopic appendectomy in pregnant women (Supplemental Digital Content 1, http://links.lww.com/SLE/A55).

Laparoscopic Lymphadenectomy for Isolated Lymph Node Recurrence in Gynecologic Malignancies

STUDY OBJECTIVE To assess the feasibility and efficacy of laparoscopic lymphadenectomy in patients with isolated lymph node recurrences (ILNR) who underwent initial surgery because of gynecologic malignancy. DESIGN Retrospective study (Canadian Task Force classification II-3). SETTING University teaching hospital. PATIENTS Six patients with ILNR (1 cervical, 4 ovarian, and 1 peritoneal) diagnosed between March 2003 and July 2010. INTERVENTION Laparoscopic lymphadenectomy. MEASUREMENTS AND MAIN RESULTS Median (range) patient age was 59.5 (24-70) years, and body mass index was 21.7 (21.0-24.6). There was no unplanned conversion to laparotomy. Operating time was 337.5 (200-400) minutes, hemoglobin change was 0.9 (0.4-2.6) g/dL, and hospital stay was 8.5 (5-19) days. The number of harvested lymph nodes was 20 (5-27), and of positive lymph nodes was 4 (1-24). One patient had common iliac vein laceration, with complete hemostasis achieved using intracorporeal suture. Postoperative lymphedema occurred in 1 patient, and was managed conservatively. All patients received adjuvant chemotherapy after laparoscopic lymphadenectomy. CONCLUSION Laparoscopic lymphadenectomy in patients with ILNR is feasible and might be an alternative therapeutic strategy.

A live birth after laparoscopic cornual resection for cornual heterotopic pregnancy after IVF-ET

A 28-year-old Korean woman with a history of both salpingectomies due to two prior tubal pregnancies at other institutions conceived a heterotopic cornual pregnancy after in vitro fertilization-embryo transfer. The patient was referred to the emergency department with an abrupt onset of lower abdominal pain at the 7th gestational week. We performed an emergent laparoscopic right cornual resection. The subsequent antenatal course was unremarkable. There were no obstetric or surgery-related complications. The patient delivered a healthy baby of 3,340 g via Cesarean section due to failure to progress at term.

Clinical efficacy on laparoscopic management of genitourinary tract injuries in gynecological surgery

Methods We conducted a retrospective study of 38 patients undergoing laparoscopic surgery to treat genitourinary tract injury which occurred during gynecologic surgery in Kangbuk Samsung Hospital from March 2003 to February 2010. We analyzed the demographic and clinical characteristics including history of previous abdominal surgery, the type of injury, type of repair procedure, and any complications.