Management of complications of Laparoscopic gynecologic surgery in a single institution

경민선,정언석,이정훈,김계현,이교원,한종설,최중섭 대한산부인과학회 2007 대한산부인과학회 학술대회 Vol.93 No.-

일반연제 보고 : 복강경하 질자궁적출술 시 복강경하 선택적 출수절제술의 임상적 고찰

정연석,이정훈,경민선,이교원,한종설,최중섭 대한산부인과학회 2007 대한산부인과학회 학술대회 Vol.93 No.-

Use of the new da Vinci Xi^® during hysterectomy :a pilot matched-case comparison with the da Vinci Si^®

박수연,임채춘,박성호,경민선,조혜연,박성택 대한산부인과학회 2016 대한산부인과학회 학술대회 Vol.102 No.-

목적: The aim of this study was to compare the short-term outcomes of robotic hysterectomy with the use of the new da V inci Xi^®and the da Vinci Si^® 방법: 40 patients underwent robot-assisted hysterectomy with the use of the new da Vinci Xi. The outcomes of Xi-Rob group were compared with a Si-Rob group selected using a case-matched methodology. 결과: There were no differences in outcomes between the two groups other than the mean weight of uterus (Xi-Rob: 243.93, Si-Rob: 216.94 grams, p=0.019). Xi-Rob was also associated with a shorter operation times((Xi-Rob: 100.2, Si-Rob: 142.58 minutes, p<0.001) and less consumption of analgesics. 결론: The new da Vinci Xi could offer some advantages with respect to the da Vinci Si in hysterectomy.

Successful Embolectomy of a Pulmonary Saddle Embolism Post-cesarean Section Complicated by Cardiac Arrest

이재준,황성미,임소영,김진,경민선,노유선 대한중환자의학회 2009 Acute and Critical Care Vol.24 No.3

A 41-year-old female underwent an uneventful cesarean section, which was followed by a pulmonary saddle embolism complicated by cardiac arrest. This case shows that successful embolectomy is possible, despite a potentially lethal pulmonary saddle embolism, 34 cm in length, and intra-operative cardiopulmonary resuscitation. We report our case and discuss the anesthetic considerations based on the literature.

난소낭종으로 오인된 복강내 이물질

최자은 ( Ja Eun Choi ),경민선 ( Min Sun Kyung ),박성택 ( Sung Taek Park ),김홍배 ( Hong Bae Kim ),박성호 ( Sung Ho Park ) 대한산부인과학회 2012 Obstetrics & Gynecology Science Vol.55 No.5

The most commonly detected foreign body in the abdominal cavity is surgical gauze or sponge, which is followed by intrauterine devices penetrating the uterine cavity. However, to the best of our knowledge, there has been no case report of a foreign body in the abdomen misdiagnosed as an ovarian cyst, in the literature. Thus, we report 1 case of a 41-year-old woman with an umbrella handle in the abdominal cavity, which was misdiagnosed as the ovarian cyst.

Synchronus Endometrioid Endometrial and Ovarian Cancer in a 37-year-old woman

박예현,이려빈,이태임,조혜연,장봉림,강정배,경민선 대한산부인과학회 2016 대한산부인과학회 학술대회 Vol.102 No.-

Synchronus primary endometrial and ovarian malignancises are uncommon. A 37-year-old women who has Hypertension visited Emergency room with the complaint of lower abdominal pain and abnormal vaginal bleeding. In Abdominopelvic computed tomography there was 11*8*3 cm sized right ovarian tumor and 10*7*3 cm sized left ovarian tumor with internal septation and diffuse endometrial thickening. Serum level of CA-125 was elevated at 65.8 IU/mL. CA 19-9 was slightly elevated at 31.4 IU/mL. An Endometrial biopsy revealed Endometrial invasive adenocarcinoma. The patient underwent Total abdominal hysterectomy with bilateral salpingo-oophorectomy and both pelvic lymphadenectomy with para-aortic lymphadenectomy and appendectomy and total omentectomy and peritonectomy and washing cytology. Histopathology revealed a synchronous endoemtrioid endometrial and ovarian cancer. After the operation, we decided to perform chemotherapy. Therefore we report a case of synchronus primary endometrial and ovarian malignancies occurred in a 37-year-old women with a brief review of the literature.

수술 중 컴퓨터단층촬영을 통해 진단된 임신 중 자연적으로 발생한 자궁동맥 파열 증례 보고

김수진,김예솔,경규상,김승호,이명화,조혜연,경민선,강정배 대한주산의학회 2023 Perinatology Vol.34 No.1

A 35-year-old pregnant woman, para 0, who had previous medical history of lymphoma, visited to our hospital at 18 weeks and 2 days of gestation with chief complaint of suprapubic pain. Small amount of abdominal fluid collection was seen on initial ultrasonography and normal appendix on magnetic resonance imaging. However, after 6 hours later, she underwent emergency diagnostic exploratory laparoscopy due to aggravating abdominal pain and hypotension. Bleeding focus was hardly found due to its location and enlarged uterus, intraoperative enhanced computed tomography (CT) scan was done and left uterine artery was identified as the site of bleeding. Spontaneous rupture of a uterine artery in pregnancy is rare and can cause fatal consequence but clinical signs and symptoms were not specific. Some bleeding sites would be difficult to find in diagnostic exploration and may cause more blood loss and worse obstetric complications. Contrast-enhanced CT can clearly confirm bleeding site comparing with other modality. Therefore, preoperative contrast CT scan can be performed to obtain better outcome.

Single Port Access Laproscopic-Assisted Vaginal Hysterectomy for benign uterine disease (초)

( Ji Eun Sung ),( Chan Eun Park ),( Yong Cho ),( Eu Sun Ro ),경민선 ( Min Sun Kyung ) 대한산부인과학회 2010 대한산부인과학회 학술대회 Vol.96 No.-

전자궁적출술 후 발생한 자궁부속기 병변의 복강경 수술에 관한 임상적 고찰

이정훈 ( Jung Hun Lee ),이효원 ( Hyo Won Lee ),경민선 ( Min Sun Kyung ),정언석 ( Un Suk Jung ),이교원 ( Kyo Won Lee ),한종설 ( Jong Sul Han ),최중섭 ( Joong Sub Choi ) 대한산부인과학회 2007 Obstetrics & Gynecology Science Vol.50 No.5

목적: 전자궁적출술 후 발생한 자궁부속기 병변에 대하여 임상적 특성과 유착 정도를 분석하고, 복강경 수술의 유용성과 효과를 평가하기 위하여 본 연구를 시행하였다. 연구 방법: 2004년 2월부터 2007년 1월까지 본원에서 전자궁적출술 후 복강경하 부속기 수술을 시행 받은 23명을 대상으로 하였다. 환자의 나이, 출산력, 부속기 종괴의 최대직경, 복강경수술의 적응증, 수술시간, 수술 전후의 혈색소치 변화, 유착 정도 평가, 이전 전자궁적출술의 수술방법 및 피부절개 방법 경로, 조직병리학적 소견, 수술 합병증 등을 연구 분석하였다. 결과: 평균 연령은 48세 (range 35∼69세)였고, 평균 출산력은 2회 (range 0∼3회)였다. 평균 수술 소요기간은 100분 (range 35∼180분), 자궁 부속기 종괴의 평균 직경은 7.1 cm (range 4∼12 cm), 수술 전, 후 (수술 1일째) 의 혈색소치 변화는 1.8 g/dL (range 0.6∼4.1 g/dL)였으며 평균 재원기간은 평균 4일 (range 3∼19일)이었다. 우측 부속기 종괴보다 좌측 부속기 종괴에서 유의하게 주위조직과의 유착 정도가 심하게 나타났다. 최종 병리 조직학적 진단은 mucinous cystadenoma 6예, 기능성 낭종 6예, 난관 수종 4예, serous cystadenoma 3예, fibrothecoma 1예, mucinous cystadenofibroma 1예, 자궁내막종 1예, 난관 난소 농양 1예였으며, 수술 중 합병증 발생과 개복술로의 전환은 없었으며, 수술 후 합병증으로 장폐색 1예가 발생하여 보존적 치료로 호전되었다. 결론: 숙련된 내시경 전문의에 의하여 심한 유착이 예견되는 전자궁적출술 후 발생한 부속기 종괴 환자에서 복강경하 자궁부속기 수술을 안전하고, 효과적으로 시행할 수 있다. 전자궁적출술 후 발생한 부속기 종괴 환자에서 좌측 부속기 종괴가 우측 부속기 종괴보다 광범위한 유착을 가지며, 이러한 소견은 high adhesion score로 나타났다. Objective: To evaluate the feasibility and effectiveness of laparoscopic adnexal surgery in posthysterectomy patients and review clinical characteristics including comparison of the adhesion score of left with that of right adnexal mass. Methods: From February 2004 to January 2007, we reviewed the medical records of 23 post-hysterectomy patients who received laparoscopic adnexal surgery including age, parity, type of hysterectomy, operative indications, histopathological diagnosis, operating time, size of the adnexal mass, adhesion score, change in the hemoglobin level, hospital stay, and any complications. Results: The median age of patients was 48 years (range 35-69 years), and median parity was 2 (0-3). The median operating time was 100 minutes (range 35-180 minutes), and the median size of the adnexal mass was 7.1 cm (range 4-12 cm). The median change in hemoglobin level was 1.8 g/dL (range 0.6-4.1 g/dL). The median hospital stay was 4 days (range 3-19 days). The adhesion score was significantly higher in the left adnexal mass than in the right adnexal mass. Histopathological diagnosis included 6 cases of mucinous cystadenoma, 6 cases of functional cyst, 4 cases of hydrosalpinx, 3 cases of serous cystadenoma, 1 case of fibrothecoma, 1 case of mucinous adenofibroma, 1 case of endometrioma, and 1 case of tubo-ovarian abscess. There were no intraoperative complications or conversion to laparotomy. One case of postoperative ileus was noted. Conclusion: The skilled laparoscopic surgeon is capable of achieving successful result by performing laparoscopic surgery primarily to patients with adnexal mass for posthysterectomy patients who are expected to suffer severe adhesion. In posthysterectomy patients, left adnexal mass has more extensive adhesion than right adnexal mass, and these finding was represented as a high adhesion score of left adnexal mass.

다양한 크기의 자궁근종 110예에 대한 복강경하 자궁근종절제술의 임상적 효용성에 대한 고찰

정언석 ( Un Suk Jung ),위혜정 ( He Jong Wie ),윤효진 ( Hyo Jin Yoon ),경민선 ( Min Sun Kyung ),이교원 ( Kyo Won Lee ),한종설 ( Jong Sul Han ),최중섭 ( Joong Sub Choi ) 대한산부인과학회 2007 Obstetrics & Gynecology Science Vol.50 No.6

목적: 복강경하 자궁근종절제술 (LM)의 유용성과 임상적 효율성에 대해 보고하고자 한다. 연구방법: 2003년 7월부터 2006년 7월까지 강북삼성병원 산부인과에서 한 명의 집도의에 의해 시행된 110예의 복강경하 자궁근종절제술에 대해 후향적인 연구를 진행하였다. 임상기록, 수술기록, 마취기록을 검토하여 환자의 연령, 출산력, 수술 기왕력, 수술적응증, 근종 크기, 수술 시간, 제거된 근종 개수, 입원 기간, 수술 전과 수술 후 1일째의 혈색소 변화, 재원기간, 동반질환, 동반수술, 수술 중, 수술 후 합병증 등을 분석하였다. 결과: 대상 환자 총 110명의 평균 연령은 35.7±5.8세이고, 평균 출산력은 0.8±0.9이었으며, 26명 (23%)에서 기왕 복강내 수술력이 있었다. 수술 적응증 대부분은 하복부 불편감을 포함한 복부 종괴 촉진, 골반통, 질출혈이 대부분이었으며, 그 외에 빈뇨, 불임이 있었다. 평균 수술 소요시간은 82.9±30.8분이었고, 주요 자궁근종의 평균 크기는 7.1±2.3 cm이었으며, 절제된 자궁근종 중 가장 무거운 것은 795 gm이었다. 수술 전, 후의 혈색소치의 평균 변화값은 2.2±1.1 g/dL이었고, 재원일수는 평균 3.5±1.4일이었다. 수술 후 수혈은 11명에서 시행하였고, 1명에서 피하기종, 2명에서 장폐쇄증이 발생하여 보존적 치료 후 회복되었으며, 개복술 전환율은 0.9% (1예)이었다. 결론: 체계적인 수술진, 숙련된 복강경 시술자 그리고 발전된 수술기법을 통해 다양한 크기의 자궁근종의 복강경하 자궁 근종절제술을 성공적이고 효율적으로 시행할 수 있으며, 개복술로의 전환을 줄일 수 있다. Objective: To assess the feasibility and clinical efficacy of laparoscopic myomectomy (LM). Methods: We analyzed retrospectively the data for 110 LM preformed at Kangbuk Samsung Hospital between July 2003 and July 2006. We reviewed their clinical charts and the operative and anesthetic records, and analyzed data on the patients` age, parity, previous operative history, preoperative indication, the diameter of the largest myoma, operating time, number of the removed myoma, hospital stay, change of the hemoglobin concentration from preoperative to postoperative day 1, concomitant procedures, histopathological reports, and complications. Results: The mean age of the patients was 35.7±5.8 years, the mean parity was 0.8±0.9, and 26 (23%) patients had a previous operative history. The most common operative indication was a palpable abdominal mass (46 patients, 41.9%), followed by chronic pelvic pain (32 patients, 29.0%), abnormal uterine bleeding (24 patients, 21.8%), urinary frequency (7 patients, 6.4%), and infertility (1 patient, 0.9%). The mean operating time was 82.9±30.8 minutes, and the mean diameter of the largest myoma was 7.1±2.3 cm. The heaviest of the removed myoma weighed 795 gm. The mean change of the hemoglobin concentration was 2.2±1.1 g/dL, and the mean hospital stay was 3.5±1.4 days. Postoperatively, transfusions were done 10% (11 cases) of patients, and 2 cases of paralytic ileus and a case of subcutaneous emphysema were noted. Conversion rate to laparotomy was 0.9% (1 case). Conclusion: LM for various sized myomas can be performed successfully and effectively by decreasing laparoconversion, if the surgical team and the laparoscopic surgeon are experienced and enhanced equipment is available.