Yong-Soon Kwon

Clinical analysis of ovarian pregnancy: a report of 49 cases.

OBJECTIVE To clinically analyze cases of ectopic ovarian pregnancy and to generate data regarding the evaluation and management of suspected ectopic ovarian pregnancies. STUDY DESIGN We retrospectively analyzed 49 ovarian pregnancies that were surgically treated at Cheil General Hospital and Womens Healthcare Center between January 1996 and December 2009. We analyzed patient age, parity, symptoms, risk factors, preoperative diagnosis, and ovarian pregnancy type. RESULTS During the study period, the incidence of ovarian pregnancy was 1.59% of all ectopic pregnancies (49/3081); 45/49 (91.8%) were primary ovarian pregnancies. At the time of diagnosis, mean age was 30.7 years (SD: ± 4.4 years) and mean parity was 0.63 (SD: ± 0.8). The most common presenting symptoms were abdominal pain (42.9%) and vaginal bleeding (28.6%). The most common sonographic findings were fluid surrounding the ovarian pregnancy and ovarian enlargement. In regard to surgical treatment, ovarian wedge resection was most often performed (85.7% of cases), followed by oophorectomy (8.2% of cases). The most common risk factors were endometriosis (16 patients) and a history of abdominal surgery (19 patients). CONCLUSIONS Ovarian pregnancies are extremely rare and difficult to diagnose both pre- and intra-operatively. Our data may assist surgeons in understanding the clinical presentation of ovarian pregnancy and in counseling patients. Larger studies are warranted to gather more data on this rare form of ectopic pregnancy.

Pregnancy outcomes after surgical treatment of ovarian pregnancy

To investigate pregnancy outcomes subsequent to ovarian pregnancy treated by surgery.

Transient occlusion of uterine arteries with endoscopic vascular clip preceding laparoscopic myomectomy.

BACKGROUND To determine whether performing transient occlusion of uterine arteries (TOUA) immediately before laparoscopic myomectomy can reduce intraoperative complications. SUBJECTS AND METHODS In a retrospective case-control study, laparoscopic myomectomy with and without TOUA was examined. Data were analyzed from 89 laparoscopic myomectomies performed by a single surgeon (Y.-S. Kwon) at Ulsan University Hospital (Ulsan, Korea) between March 2011 and December 2011. Surgical outcomes included preoperative myoma size, number of myoma, operative time, and operative blood loss. RESULTS Forty-nine women underwent laparoscopic myomectomy with TOUA with endoscopic vascular clipping, whereas 40 control patients underwent laparoscopic myomectomy alone. The TOUA group had no case of nerve or vascular injury during the operation time. The mean time of occlusion of both the uterine arteries was 15 minutes. The TOUA group had less mean blood loss during the operation than the group with laparoscopic myomectomy alone (111.9 versus 203.4 mL; P<.001). There were no significant differences in size and number of uterine myomas and intraoperative complications between the two groups. Moreover, there was not even a single case of conversion of laparoscopy to laparotomy in either group. CONCLUSIONS TOUA performed immediately before laparoscopic myomectomy facilitated minimally invasive surgery with lower blood loss and no differences in other intraoperative complications.

Treatment for Postoperative Wound Pain in Gynecologic Laparoscopic Surgery: Topical Lidocaine Patches

BACKGROUND This article reports our early experience with the use of lidocaine patches for pain control in the immediate postoperative period after laparoscopic gynecologic surgery. SUBJECTS AND METHODS A prospective, double-blind, placebo-controlled clinical trial was conducted on 40 patients undergoing a gynecologic laparoscopy who were randomized to receive either topical patches of 700 mg of lidocaine (n=20) or placebo patches (n=20). The patch was divided evenly into four smaller patches, which were applied at the four port sites and changed every 12 hours for 36 hours after surgery. Postoperative pain was evaluated using the visual analog scale (VAS) score and the Prince Henry and 5-point verbal rating pain scale (VRS), and the analgesic requirement was also evaluated at 1, 6, 12, 24, and 36 hours after surgery. RESULTS The VAS score for wound pain was lower in the lidocaine patch group at 1 and 6 hours after surgery than the control group (P=.005 and <.0005, respectively). The VAS scores for postoperative pain were lower in the lidocaine patch group at rest 1 hour after surgery (P=.045). The 5-point VRS score for postoperative pain was lower in the lidocaine patch group at 6 and 12 hours after surgery (P=.015 and .035, respectively) than in the control group. CONCLUSIONS Topical lidocaine patches at the laparoscopic port sites reduced postoperative pain, particularly postoperative wound pain after gynecological laparoscopic procedures.

Laparoendoscopic single-site surgery versus conventional laparoscopic surgery for adnexal tumors: A comparison of surgical outcomes and postoperative pain outcomes

The objective of this study was to show the feasibility of laparoendoscopic single‐site surgery (LESS) by comparing the surgical outcomes and postoperative pain of LESS with conventional laparoscopic surgery (CLS) for gynecologic adnexal tumor. This is a prospective case–control study. We enrolled 33 patients—one in 18 patients for LESS and the other in 15 patients for CLS—who were diagnosed with evident adnexal tumor consecutively from September 2009 to February 2010 and were performed by a single surgeon. In LESS, all procedures were performed successfully without any case of conversion to CLS. There were no differences in the demographic characteristics between the two groups. The pathological findings were similar in both groups; a mucinous cystadenoma was the most common pathological feature. The most common operative type performed was cystectomy (22/33, 66%). There were no differences between the LESS and CLS groups in median operation time (62.8 minute vs. 51.3 minutes, p = 0.073); estimated blood loss during operation (100 mL vs. 128 mL, p = 0.068); and postoperative pain intensity measured by visual analog scale. There were no major complications in either group, including operative wound complications. Our study suggested that LESS for adnexal tumor is a feasible surgical technique through the comparable data of the surgical outcomes and postoperative pain outcomes.

Single-port transumbilical laparoscopic-assisted adnexal surgery.

Single-port transumbilical laparoscopic-assisted surgery for large, benign adnexal tumors was found to be a feasible alternative to conventional laparoscopic or open surgical methods.

Conservative adenomyomectomy with transient occlusion of uterine arteries for diffuse uterine adenomyosis.

This study aimed to determine the feasibility and safety of adenomyomectomy with transient occlusion of uterine arteries (TOUA) in patients with symptomatic diffuse uterine adenomyosis.

Mature cystic teratoma of the uterosacral ligament successfully treated with laparoendoscopic single-site surgery.

OBJECTIVE Although the majority of teratomas are encountered in the ovary, extragonadal mature cystic teratoma is an unusual disease entity, and the most common site is the omentum. CASE REPORT The occurrence of this tumor on a uterosacral ligament is extremely rare with enigmatic etiology. To our knowledge, there have been only three cases reported to date that describe a mature cystic teratoma of the uterosacral ligament, and this is the first report of successful treatment of these rare tumors with laparoendoscopic single-site surgery (LESS). CONCLUSION In the present study, we report a mature cystic teratoma of the uterosacral ligament successfully treated with LESS in a 34-year-old woman with a preoperative diagnosis of mature cystic teratoma of the left ovary.

Adenoma malignum of the uterine cervix: Clinicopathologic analysis of 18 cases

The aim of this study was to evaluate the clinical and pathologic features of a rare tumor (adenoma malignum, AM). We retrospectively analyzed the medical records of 18 patients diagnosed with AM at a single institute between March 1992 and November 2009. The median age of the patients was 45.8 years (range 29–76 years) and the mean follow‐up period was 49.2 months (range 4–168 months). A preoperative cytologic diagnosis (Papanicolaou smear) of AM was made in 22.2% (4/18) of the cases. Ten (55.6%) of the 18 patients were misdiagnosed with other benign diseases and underwent hysterectomies, which confirmed AM. Sixteen patients with AM were in the early stage (IB1, 11/18; IB2, 5/18) and the other two patients were in the advanced stage. Fourteen of 18 patients (77.8%) had pure AM alone. Adjuvant therapy was administered to eight of the patients (44.4%) with AM. The recurrence rate was zero, but the disease progressed in two of the patients (11.1%), who died of the disease. The 5‐year survival rate was 88.8%. A cytological diagnosis of AM based on a Papanicolaou smear is rarely made; a deep biopsy (cone biopsy or endocervical curettage) is necessary to diagnose this rare tumor preoperatively when there is any clinical suspicion of AM.

Ovarian microcystic stromal tumor: A novel extracolonic tumor in familial adenomatous polyposis

Ovarian microcystic stromal tumor (MCST) is a very rare neoplasm; hence, its nomenclature was recently designated as “Distinctive morphologic and immunohistochemical features” in 2009. Its exact origin, etiological genetic alterations, and background are not yet clearly known. Familial adenomatous polyposis (FAP) is an autosomal dominant disease that leads to development of colorectal polyps via germ‐line mutations of the APC gene on chromosome 5q21∼22. In this study, we report a 40‐year‐old female patient who had ovarian MCST and FAP. On sequencing the APC gene in ovarian MSCT, we detected a novel somatic mutation of the APC gene in exon 11, with a heterozygous deletion at nucleotide position c.1540delG (p.Ala514 Profs*9). Mutations of β‐catenin (CTNNB1) and FOXL2 were not detected. Although one case demonstrating involvement of Wnt/β‐catenin in ovarian MCST associated with FAP has been presented previously, no detailed information was provided. Thus, this is the ovarian MCST with a somatic mutation of APC in a patient with FAP.