Yoon Soon Lee

Benefit of uterine artery ligation in laparoscopic myomectomy

OBJECTIVEnTo determine the impact of uterine artery ligation in laparoscopic myomectomy, according to surgical results and clinical outcomes.nnnDESIGNnSingle-center, nonrandomized, comparative study.nnnSETTINGnUniversity hospital, tertiary referral center.nnnPATIENT(S)nNinety women undergoing laparoscopic myomectomy.nnnINTERVENTION(S)nLaparoscopic myomectomy with or without uterine artery ligation.nnnMAIN OUTCOME MEASURE(S)nSurgical results and clinical outcomes.nnnRESULT(S)nFifty-one patients (56.6%) underwent laparoscopic myomectomy with uterine artery ligation (group A), and 39 patients (43.3%) underwent laparoscopic myomectomy alone (group B). The mean operating time was 100.0 ± 33.8 minutes in group A and 90.0 ± 37.1 minutes in group B. Both groups were similar with respect to mean blood loss (72.3 ± 109.0 mL vs. 62.6 ± 77.3 mL). The myoma recurrence rate in group A was significantly less than in group B after a median follow-up period of 11.1 months (2% vs. 13%).nnnCONCLUSION(S)nBoth groups were similar with respect to surgical results. However, the recurrence rate was significantly lower in group A compared with group B.

Laparoscopic pelvic anatomy of nerve-sparing radical hysterectomy

Many reports regarding nerve‐sparing radical hysterectomy have been published. However, most reports have been based on systematic descriptions via laparotomy or cadaver dissection. The aim of this work was to describe the pelvic anatomy of nerve‐sparing radical hysterectomy via laparoscopy, with specific focus on the inferior hypogastric plexus. This study is based on 125 patients with FIGO stage IB cervical cancer who had undergone laparoscopic nerve‐sparing radical hysterectomies since 1999. The inferior hypogastric plexus was demonstrated via laparoscopy and was comprised of afferent fibers from the sacral root (S2, S3, and S4), sacral sympathetic ganglion, and hypogastric nerve, and efferent fibers forming its vesical, uterovaginal, and rectal branches. During the dissection of the posterior leaf of the vesicouterine ligament, various vesical veins were identified. If the cut edge of an inferior vesical vein was pulled medially with upward traction, the vesical branches of the inferior hypogastric plexus were exposed and these were divided into medial and lateral branches. The magnified view of laparoscopy made it possible to dissect nerves and vessels meticulously and to secure a clear resection margin during the dissection of the deep part of the cardinal ligament, uterosacral ligament, and posterior leaf of the vesicouterine ligament. Clin. Anat. 23:186–191, 2010.

EARLY EXPERIENCE WITH LAPAROSCOPIC PELVIC LYMPHADENECTOMY IN WOMEN WITH GYNECOLOGIC MALIGNANCY

STUDY OBJECTIVESnTo compare the results of laparoscopic pelvic lymphadenectomy with those of open lymphadenectomy; to assess differences in lymph node yield, operating time, and rate of positive nodes based on experience (early and late); and to evaluate the clinical course of laparoscopic lymphadenectomy.nnnDESIGNnRetrospective case review (Canadian Task Force classification II-2).nnnSETTINGnUniversity-affiliated hospital.nnnPATIENTSnSixty-one women with cervical cancer, one with vaginal cancer, and one with endometrial cancer.nnnINTERVENTIONSnLaparoscopic lymphadenectomy followed by laparotomy or radical vaginal hysterectomy was performed in 19 women between 1994 and 1995, and radical abdominal hysterectomy with pelvic lymphadenectomy was performed in 44 women between 1993 and 1995. MEASUREMENTS AND MAIN RESULTS. Mean lymph node yields at laparoscopic pelvic lymphadenectomy were significantly increased in the group operated during the last 6 months compared with the first 6 months (16.2 +/- 6.8 vs 33.2 +/- 10. 5, p <0.05). After 6 months experience, lymph node yields were 23.9 +/- 10.3 for laparoscopic lymphadenectomy followed by laparotomy and 23.2 +/- 10.2 for laparoscopic lymphadenectomy followed by radical vaginal hysterectomy (NS). The rate of positive lymph nodes was not significantly different between procedures, 16% and 14%, respectively. Operating time for laparoscopic lymphadenectomy was significantly shorter in the last 6 months (143 +/- 34 vs 78 +/- 18 min, p <0.05). Major complications of the procedure were injury to aberrant obturator and iliac veins in two cases in the early period. Average blood loss was 150 to 350 ml. Two women died due to disease recurrence at minimum of 2.5 years follow-up; the others were alive without recurrence.nnnCONCLUSIONnLaparoscopic pelvic lymphadenectomy was feasible and safe, and did not compromise short-term survival. A learning curve was associated with the procedure, but after a period of learning, pelvic lymphadenectomy can be performed as effectively by laparoscopy as by laparotomy. (J Am Assoc Gynecol Laparosc 6(1):59-63, 1999)

Prediction of high-grade squamous intraepithelial lesions using the modified Reid index

BackgroundColposcopic grading provides an objective and meaningful guide to histologic severity and neoplastic progression of squamous intraepithelial lesions of the cervix. The objective of this study was to develop a more efficient and convenient method to overcome procedural complexities involved with the traditional Reid index in prediction of high-grade squamous intraepithelial lesion (HSIL).MethodsThe Reid index uses four colposcopic signs (margin, color, vessel, and iodine staining). The proposed modified Reid index system specifically incorporates the location of the lesion within the transformation zone in place of iodine staining. Three hundred women with suspected or abnormal cytologies or abnormal cervicographic findings were evaluated by colposcopy, directed biopsy, and HPV testing by the Hybrid Capture II method, which detects high-risk HPV DNA types.ResultsThe sensitivity of high-risk HPV testing for detecting HSIL was 94.4%, the specificity was 65.0%, the positive predictive value was 75.5%, and the negative predictive value was 91.0%. The results of the colposcopic impression using the modified Reid index were superior to HPV testing. The sensitivity, specificity, positive predictive value, and negative predictive value of the colposcopic impression for detecting HSIL were 91.3, 92.9, 93.6, and 90.3% respectively.ConclusionThese results strongly indicate that the modified Reid index can accurately predict the histologic grade of squamous intraepithelial lesions of the cervix and can be applied easily and objectively in clinical practice without affecting the diagnostic accuracy of the traditional Reid index.

Vaginal evisceration after total laparoscopic radical hysterectomy in cervical cancer

A 50-year-old woman came to the emergency department with vaginal evisceration that occurred 7 months after a total laparoscopic radical hysterectomy. Vaginal evisceration was repaired by a laparoscopic-vaginal approach without a laparotomy. This is the first report of vaginal evisceration after a total laparoscopic radical hysterectomy.

Sonographic diagnosis of a viable abdominal pregnancy with planned delivery after fetal lung maturation.

We report a case of a viable abdominal pregnancy with successful outpatient management until fetal lung maturation and planned delivery. Advanced abdominal pregnancy is a very rare extrauterine pregnancy, which results in serious maternal and fetal morbidity. A 28‐year‐old nullipara was referred from the local clinic to our tertiary center at 18 weeks gestation. We diagnosed an extrauterine fetus on sonographic examination. The patient had weekly antenatal sonographic examinations. We performed a planned laparotomy at 34 weeks gestation, and a female baby weighing 2,100 g was delivered. The placenta was completely removed and the uterus was preserved. Both the mother and the baby had no postoperative morbidity.

Laparoscopic Removal of a Rusty Sewing Needle from the Pelvis

he authors have no commercial, proprietary, or financial interest in the roducts or companies described in this article. orresponding author: Yoon S. Lee, PhD, Department of Obtetrics and Gynecology, Kyungpook National University Hospital, School of edicine, 50 Samdok-2 Ga, Chung-Gu, Daegu, Korea 700-721. ig. 1. Preoperative plane abdominal radiography shows radioopaque linar material in pelvic cavity.

A case of uterine pseudoaneurysm combined with gestational trophoblastic disease in a 30-year-old woman

Abstract Uterine artery pseudoaneurysm is a rare disease and it can be diagnosed using conventional doppler ultrasongraphy. Damaged uterine arteries from cesarean section, myomectomy, dilatation & curettage, etc. are known as causes of the disease. Massive bleeding in the rupture can cause fatal result. We observed an increase in β-hCG and uterine artery pseudoaneurysm a year after the performance of dilatation & curettage for hydatidiform mole and treated it with arterial embolization and chemotherapy. We report the case and give a brief review of the literature.