Jung-Joo An

Does single-port access (SPA) laparoscopy mean reduced pain? A retrospective cohort analysis between SPA and conventional laparoscopy

OBJECTIVE To compare perioperative outcomes, including pain, between single-port access (SPA) and conventional laparoscopy in patients with presumed benign gynecological adnexal diseases. Study design A retrospective cohort study was performed at Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea. All operations in each group were performed consecutively by a single surgeon. RESULTS A total of 188 patients were enrolled, with 94 patients per group. Baseline characteristics before surgery were similar between groups. Visual analogue scale pain scores 24h after laparoscopy were lower in the SPA group than in the conventional laparoscopy group (2, 0-7 vs. 3, 2-6 P=0.006). In addition, we found that the SPA group had less supplementary analgesic use (parenteral Ketoprofen intramuscular injection, 1 ampule=100mg) per patient after surgery compared to that in the conventional group (1 ampule, 0-7 vs. 2 ampule, 0-6, P=0.010). CONCLUSIONS These results add to the evidence suggesting an advantage of SPA laparoscopy over conventional laparoscopy in terms of decreasing postoperative pain. Additional large, randomized controlled trials are needed to confirm these findings and to investigate long-term outcomes such as quality of life and cosmesis.

Clinical characteristics and perinatal outcome of fetal hydrops.

Objective To investigate the clinical characteristics of fetal hydrops and to find the antenatal ultrasound findings predictive of adverse perinatal outcome. Methods This is a retrospective study of 42 women with fetal hydrops who delivered in a tertiary-referral center from 2005 to 2013. Fetal hydrops was defined as the presence of fluid collection in ≥2 body cavities: ascites, pleural effusion, pericardial effusion, and skin edema. Predictor variables recorded included: maternal characteristics, gestational age at diagnosis, ultrasound findings, and identifiable causes. Primary outcome variables analyzed were fetal death and neonatal death. Results The mean gestational age at diagnosis was 29.3±5.4 weeks (range, 18 to 39 weeks). The most common identifiable causes were cardiac abnormality (10), followed by syndrome (4), aneuploidy (3), congenital infection (3), twin-to-twin transfusion syndrome (3), non-cardiac anormaly (2), chorioangioma (2), inborn errors of metabolism (1), and immune hydrops by anti-E antibody isoimmunization (1). Thirteen cases had no definite identifiable causes. Three women elected termination of pregnancy. Fetal death occurred in 4 cases. Among the 35 live-born babies, only 16 survived (54.0% neonatal mortality rate). Fetal death and neonatal mortality rate was not significantly associated with Doppler velocimetry indices or location of fluid collection, but increasing numbers of fluid collection site was significantly associated with a higher risk of neonatal death. Conclusion The incidence of fetal hydrops in our retrospective study was 24.4 per 10,000 deliveries and the perinatal mortality rate was 61.9% (26/42). The number of fluid collection sites was the significant antenatal risk factor to predict neonatal death.

Outcome of isolated fetal renal pyelectasis diagnosed during midtrimester screening ultrasound and cut-off value to predict a persistent or progressive pyelectasis in utero.

Abstract Aim: To define a better cut-off value of the renal pelvis anteroposterior diameter (RPAPD) to predict persistent or progressive pyelectasis during pregnancy. Methods: We retrospectively reviewed 8873 women whose fetal RPAPD was measured. Midtrimester pyelectasis was defined as a RPAPD of ≥4 mm. Persistent/progressive pyelectasis was defined as a RPAPD of ≥10 mm before delivery. A RPAPD cut-off value to predict a persistent/progressive pyelectasis was determined by receiver operating characteristic curve analysis. Results: Among 249 isolated cases of pyelectasis, persistent/progressive pyelectasis was found in 6.9% before delivery. The midtrimester RPAPD cut-off value that best predicted persistent/progressive pyelectasis before delivery was ≥6 mm with sensitivity, specificity, positive and negative predictive values of 64.3%, 88.7%, 30.0%, and 97.1%, respectively. Conclusions: Although most cases of midtrimester fetal pyelectasis regress to normal during pregnancy, those with a RPAPD of ≥6 mm in the midtrimester are at higher risk for persistent or progressive pyelectasis.

Prognostic value of pre-treatment SCC-Ag level in patients with cervical cancer

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PORT-SITE METASTASIS OF ADVANCED PRIMARY PERITONEAL CANCER AFTER LAPAROSCOPIC PERITONEAL BIOPSY: A CASE REPORT

Due to the advancement in laparoscopic surgery in gynecology, laparoscopic surgery of patients with gynecologic malignancy is widely used. A 69-year-old woman who had elevated serum level of CA-125 and malignant ascites was transferred from general surgery after laparoscopic peritoneal biopsy. She complained about 2.5 cm sized abdominal wall mass which developed only 1week after surgery. With the impression of ovarian cancer with port-site metastasis, we performed debulking operation and abdominal wall mass excision. The final pathology confirmed primary peritoneal serous papillary adenocarcinoma. Whenever a female patient has elevated serum level of CA-125 and ascites cytology shows adenocarcinoma, she should be referred to gynecologic oncologists fiAnd considering the primary peritoneal or ovarian cancer, primary debulking operation by gynecologic oncolog ist is recommended.