Joong Sub Choi

A Prospective Matched Case-Control Study of Laparoendoscopic Single-Site vs Conventional Laparoscopic Myomectomy

STUDY OBJECTIVE To compare operative and obstetric outcomes of laparoendoscopic single-site myomectomy (LESS-M) vs conventional laparoscopic myomectomy (LM). DESIGN Prospective matched case-control study. SETTING A university hospital and a tertiary care center. PATIENTS Forty-five women underwent LESS-M, and 90 women underwent conventional LM. INTERVENTION LESS-M or conventional LM. MEASUREMENTS AND MAIN RESULTS Operative and obstetric outcomes. There were no significant differences between the 2 groups in demographic characteristics, operative time (135 vs 140 minutes), change in hemoglobin concentration (1.9 vs 1.95 g/dL), return of bowel activity (35 vs 28 hours), hospital stay (5 vs 5 days), or complication rate (11.1% vs 8.9%). Insofar as obstetric outcomes, no significant differences were observed between the 2 groups for duration of follow-up (24.4 vs 23.2 months), pregnancy rate in patients who desired pregnancy (66.7% vs 50.0%), full-term delivery rate (66.7% vs 58.3%), and time to first pregnancy after surgery (7.6 vs 10.1 months). CONCLUSION LESS-M is feasible and safe and has comparable obstetric outcomes to conventional LM in selected women with symptomatic myomas. However, a large prospective randomized study is needed.

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.

Laparoscopic management of pelvic splenosis

Splenosis is defined as heterotopic autotransplantation of spleen tissue following traumatic rupture of the spleen, or surgery. It is a benign disease that is generally without any symptoms and is discovered incidentally. Surgical intervention is recommended if symptoms are present. We report the successful laparoscopic management of a 49-year-old Korean woman with splenosis-associated symptoms who had undergone splenectomy.

1p36.22 region containing PGD gene is frequently gained in human cervical cancer

To identify commonly occurring DNA copy number alterations in Korean cervical cancers.

Safety of laparoscopically assisted vaginal hysterectomy for women with anterior wall adherence after cesarean section

Objective To evaluate the safety and surgical outcomes of laparoscopically assisted vaginal hysterectomy (LAVH) for women with anterior wall adherence after cesarean section. Methods We conducted a retrospective study of 328 women with prior cesarean section history who underwent LAVH from March 2003 to July 2013. The subjects were classified into two groups: group A, with anterior wall adherence (n=49); group B, without anterior wall adherence (n=279). We compared the demographic, clinical characteristics, and surgical outcomes of two groups. Results The median age and parity of the patients were 46 years (range, 34 to 70 years) and 2 (1 to 6). Patients with anterior wall adherence had longer operating times (175 vs. 130 minutes, P<0.05). There were no significant differences in age, parity, number of cesarean section, body mass index, specimen weight, postoperative change in hemoglobin concentration, or length of hospital stay between the two groups. There was one case from each group who sustained bladder laceration during the vaginal portion of the procedure, both repaired vaginally. There was no conversion to abdominal hysterectomy in either group. Conclusion LAVH is effective and safe for women with anterior wall adherence after cesarean section.

Feasibility and efficacy of laparoscopic restaging surgery for women with unexpected ovarian malignancy.

OBJECTIVE To evaluate the feasibility, surgical outcomes and complications of laparoscopic restaging surgery for women with unexpected ovarian malignancy. STUDY DESIGN We conducted a retrospective chart review of 14 women with unexpected ovarian malignancy who underwent laparoscopic restaging surgery including peritoneal washing cytology, laparoscopic pelvic and paraaortic lymphadenectomy up to the left renal vein level, omentectomy, and multiple peritoneal biopsies, and hysterectomy except three fertility saving surgery. RESULTS The median age and median body mass index women were 49 years (range, 22-63) and 24.2m/kg(2) (range, 18.9-25.3), respectively. The median operating time was 230min (range, 155-370). The median numbers of harvested pelvic and paraaortic lymph nodes were 26 (range, 6-41) and 18 (range, 2-40), respectively. The median return of bowel activity was 28h (range, 21-79). Four of the women were upstaged from the initial presumed stage. There were two intraoperative complications, laceration of the inferior vena cava and cisterna chyli rupture. There was one postoperative complication, port-site metastasis. There was no conversion to laparotomic surgery. The median follow-up period was 33 months. Thirteen of the patients have no evidence of recurrences, however one patient died after 22 months after the surgery. CONCLUSION Laparoscopic restaging surgery, performed by a specialized laparoscopic oncologist with sufficient laparoscopic experience and a well-trained operating team, is both feasible and effective in the management of unexpected ovarian malignancies.

Coexisting ovarian and tubal pregnancies on opposite sides after intrauterine insemination: a case report

BackgroundOvarian pregnancy is very rare, and contralateral tubal pregnancy coexisting with ovarian pregnancy must be even rarer.Case presentationA 33-year-old Korean nulliparous woman was referred to our hospital because she suffered lower abdominal pain and had missed her periods after controlled ovarian hyperstimulation and intrauterine insemination. We could not identify any normal gestational sac in the endometrium, or specific ectopic pregnancies, on an initial ultrasound scan. However, there was a large hematoma in the cul-de-sac and free fluid in the right paracolic gutter. We decided to perform emergent laparoscopic surgery. We found contralateral tubal and ovarian ectopic pregnancies.ConclusionTo the best of our knowledge, this is the first report of a case in which a patient underwent laparoscopic right salpingectomy and left ovarian ectopic mass excision due to contralateral tubal and ovarian ectopic pregnancies after assisted reproductive technology.

Preoperative diagnostic clues to ovarian pregnancy: retrospective chart review of women with ovarian and tubal pregnancy

Objective To analyze the preoperative diagnostic clues to ovarian pregnancy (OP). Methods This study conducted a retrospective chart review of 23 patients with OP and 46 patients with tubal pregnancy (TP) from October 1, 2003 to September 31, 2016 in Hanyang University Hospital. Results There were no significant differences in demographic and clinical characteristics between the two groups. The presence of an ectopic gestational sac and hemoperitoneum was significantly higher in the TP group (13.0% vs. 95.7%, P=0.000; 13.0% vs. 54.3%, P=0.001, respectively) in preoperative ultrasonogram. The OP group had more ruptured ectopic gestational sacs than the TP group (73.9% vs. 45.7%, P=0.039) in surgical findings. Conclusion For the patients in whom a gestational sac is not detected in the uterus or the fallopian tubes, it is important to be aware of the possibility of OP and rupture of an ovarian gestational sac to promote early diagnosis and surgical intervention.

Laparoscopic treatment of Castleman's disease in a patient with a history of malignant Brenner tumor.

Castlemans disease (CD) is a rare, atypical, lymphoproliferative disease of unknown etiology. The most common location for CD is the mediastinum (63%) [1]. A retroperitoneal location has been reported in 7% of patients, with only 2% of cases involving the pararenal region [2]. For this reason, CD located in the retroperitoneum is difficult to differentiate from other benign or malignant lesions. Here, we report a patient with CD located in the anterior lower pole of the right kidney who had been diagnosed with a malignant Brenner tumor after hysterectomy. A 56-year-oldwoman visited our hospital with a chief complaint of a growing abnormal retroperitoneal mass. She had undergone a total abdominal hysterectomy (TAH) and bilateral salpingooophorectomy (BSO) due to a malignant Brenner tumor at another university hospital 3 months previously. Baseline serum levels of CA-125 and CA 19-9 were normal (5.59 U/mL and 8.11 U/ mL, respectively). An abdominal computed tomography (ACT) scan revealed a 3.0-cm nodule in the anterior lower pole of the right kidney that had been visualized by ACT prior to the TAH and BSO. The mass had increased in size over the course of 3 months (Figure 1). No distant metastases or other abnormal findings were noted on ACT. We suspected that the mass was a metastatic lymph node and performed laparoscopic retroperitoneal removal. The patient was placed in the dorsolithotomy position, and four ports were used for the procedure (Figure 2). The first assistant gradually rotated the telescope 180 clockwise from the pelvic