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임가원,김영태,김상운,남은지,김성훈,김희정 연세대학교의과대학 2014 Yonsei medical journal Vol.55 No.5
Purpose: To compare surgical outcomes of robotic radical hysterectomy (RRH) using3 robotic arms with those of conventional laparoscopy in patients with early cervicalcancer. Materials and Methods: A retrospective cohort study included 102 patientswith stage 1A1-IIA2 cervical carcinoma, of whom 60 underwent robotic and 42 underwent laparoscopic radical hysterectomy (LRH) with pelvic lymph node dissectionperformed between December 2009 and May 2013. Perioperative outcomes were compared between two surgical groups. Results: Robotic approach consisted of 3 robotic arms including the camera arm and 1 conventional assistant port. Laparoscopicapproach consisted of four trocar insertions with conventional instruments. There were no conversions to laparotomy. Mean age, body mass index, tumor size, cell type, and clinical stage were not significantly different between two cohorts. RRH showed favorable outcomes over LRH in terms of estimated blood loss (100 mL vs. 145 mL, p=0.037), early postoperative complication rates (16.7% vs. 30.9%, p=0.028), and postoperative complications necessitating intervention by Clavien-Dindo classification. Total operative time (200.5±61.1 minutes vs. 215.6±83.1 minutes,p=0.319), mean number of lymph node yield (23.3±9.3 vs. 21.7±9.8, p=0.248), and median length of postoperative hospital stay (11 days vs. 10 days, p=0.129) were comparable between robotic and laparoscopic group, respectively. The median follow-up time was 44 months with 2 recurrences in the robotic and 3 in the laparoscopiccohort. Conclusion: Surgical outcomes of RRH and pelvic lymphadenectomywere comparable to that of laparoscopic approach, with significantly less blood loss and early postoperative complications.
임가원,김영태,김상운,남은지,김성훈 연세대학교의과대학 2015 Yonsei medical journal Vol.56 No.2
Purpose: The aim of this study was to evaluate perioperative complications of robot-assisted laparoscopic surgery in gynecology. Materials and Methods: Patientswho underwent elective robot-assisted laparoscopic surgery between February2006 and December 2013 were identified. Robotic procedures were performed using the da Vinci robotic system. Patient demographic data and operative outcomeswere prospectively collected in a computerized database and extracted for this study. Results: Two hundred and ninety eight patients were identified during the study period. One case was converted to conventional laparoscopy due to mechanicalfailure of the robot system before the procedure and excluded from review. The median age and body mass index of patients were 48 years and 23.0 kg/m2, respectively. The majority (n=130, 43.6%) of operative procedures was radical hysterectomy, followed by endometrial cancer staging (n=112, 37.6%), total hysterectomy(n=39, 13.1%), and myomectomy (n=17, 5.7%). The median operative time, estimated blood loss, and postoperative hospital stay were 208.5 min, 184.8 mL, and 8.9 days, respectively. The overall complication rate was 18.8% and that for only oncologic cases was 16.1%. Intraoperative complications (n=5, 1.7%) consisted of three vessel injuries, one bowel content leakage during an appendectomyduring endometrial cancer staging and one case of bladder injury during radicalhysterectomy. Early and late postoperative complications were 14.4% and 2.7%, respectively. Five patients (1.7%) experienced grade 3 complications accordingto Clavien-Dindo classification and therefore needed further intervention. Conclusion: Robot-assisted laparoscopic surgery is a feasible approach in gynecologywith acceptable complications.
임가원,김상운,남은지,김성훈,김영태 대한부인종양학회 2013 Journal of Gynecologic Oncology Vol.24 No.4
Objective: The aim of this study was to evaluate the learning curve and perioperative outcomes of robot-assisted laparoscopic procedure for cervical cancer. Methods: A series of 65 cases of robot-assisted laparoscopic radical hysterectomies with bilateral pelvic lymph node dissection for early stage cervical cancer were included. Demographic data and various perioperative parameters including docking time, console time, and total operative time were reviewed from the prospectively collected database. Console time was set as a surrogate marker for surgical competency, in addition to surgical outcomes. The learning curve was evaluated using cumulative summation method. Results: The mean operative time was 190 minutes (range, 117 to 350 minutes). Two unique phases of the learning curve were derived using cumulative summation analysis; phase 1 (the initial learning curve of 28 cases), and phase 2 (the improvement phase of subsequent cases in which more challenging cases were managed). Docking and console times were significantly decreased after the first 28 cases compared with the latter cases (5 minutes vs. 4 minutes for docking time, 160 minutes vs. 134 minutes for console time; p<0.001 and p<0.001, respectively). There was a significant reduction in blood loss during operation (225 mL vs. 100 mL, p<0.001) and early postoperative complication rates (28% vs. 8.1%, p=0.003) in phase 2. No conversion to laparotomy occurred. Conclusion: Improvement of surgical performance in robot-assisted surgery for cervical cancer can be achieved after 28 cases. The two phases identified by cumulative summation analysis showed significant reduction in operative time, blood loss, and complication rates in the latter phase of learning curve.
임가원,김영태,남은지,김상운 연세대학교의과대학 2014 Yonsei medical journal Vol.55 No.3
Purpose: The aim of this study was to compare survival of patients with uterine sarcomas using the 1988 and 2008 International Federation of Gynecologists and Obstetricians (FIGO) staging systems to determine if revised 2008 staging accuratelypredicts patient survival. Materials and Methods: A total of 83 patients with leiomyosarcoma and endometrial stromal sarcoma treated at Yonsei UniversityHealth System between March of 1989 and November of 2009 were reviewed. The prognostic validity of both FIGO staging systems, as well as other factors was analyzed. Results: Leiomyosarcoma and endometrial stromal sarcoma comprised 47.0% and 53.0% of this study population, respectively. Using the new staging system, 43 (67.2%) of 64 eligible patients were reclassified. Among those 64 patients,45 (70.3%) patients with limited uterine corpus involvement were divided into stage IA (n=14) and IB (n=31). Univariate analysis demonstrated a significant difference between stages I and II and the other stages in both staging systems (p<0.001) with respect to progression-free survival and overall survival (OS). Age, menopausal status, tumor size, and cell type were significantly associated with OS (p=0.011, p=0.031, p=0.044, p=0.009, respectively). In multivariate analysis, revisedFIGO stage greater than III was an independent poor prognostic factor with a hazard ratio of 9.06 [95% confidence interval (CI) 2.49-33.0, p=0.001]. Conclusion:The 2008 FIGO staging system is more valid than the previous FIGO staging system for uterine sarcomas with respect to its ability to distinguish early-stage patientsfrom advanced-stage patients.
OK-432 흉막유착술에 의한 자궁내 조기 태아 유미흉의 치료
임가원 ( Ga Won Yim ),권자영 ( Ja Young Kwon ),박용원 ( Yong Won Park ),김영한 ( Young Han Kim ) 대한산부인과학회 2009 Obstetrics & Gynecology Science Vol.52 No.7
Fetal chylothorax is a rare congenital manifestation that shows variable clinical outcome ranging from complete spontaneous resolution to progression into hydrops or lung hypoplasia. There is no consensus in the literature as to the optimal antenatal management despite several complications such as preterm delivery, pulmonary hypoplasia, and perinatal death. Pleuroamniotic shunting has been the treatment of choice in fetal chylothorax. Recently, new fetal therapy such as OK-432 (Picibanil) pleurodesis is being introduced. Herein, we present two cases of women referred at early 2nd trimester because of fetal hydrothorax by routine ultrasonography. Cytology obtained by thoracocentesis revealed abundant lymphocytes, suggesting chylothorax. Effusion was aspirated and OK-432 (Picibanil) was injected into the pleural space of fetus. On follow up ultrasonography, the pleural effusion was nearly resolved by adhesion of the intrathoracic space and resulted in the delivery of a healthy neonate. Intrapleural OK-432 injection may be feasible therapeutic option for selected cases in early 2nd trimester with persistent chylothorax for effective control of pleural effusion with no adverse effects.