Surgical technique for single-port laparoscopy in huge ovarian tumors: SW Kim`s technique and comparison to laparotomy

( Jeong Sook Kim ),( In Ok Lee ),( Kyung Jin Eoh ),( Young Shin Chung ),( Inha Lee ),( Jung-yun Lee ),( Eun Ji Nam ),( Sunghoon Kim ),( Young Tae Kim ),( Sang Wun Kim ) 대한산부인과학회 2017 Obstetrics & Gynecology Science Vol.60 No.2

Objective This study aimed to introduce a method to remove huge ovarian tumors (≥15 cm) intact with single-port laparoscopic surgery (SPLS) using SW Kim`s technique and to compare the surgical outcomes with those of laparotomy. Methods Medical records were retrospectively reviewed for patients who underwent either SPLS (n=21) with SW Kim`s technique using a specially designed 30×30-cm2-sized 3XL LapBag or laparotomy (n=22) for a huge ovarian tumor from December 2008 to May 2016. Perioperative surgical outcomes were compared. Results In 19/21 (90.5%) patients, SPLS was successfully performed without any tumor spillage or conversion to multi-port laparoscopy or laparotomy. There was no significant difference in patient characteristics, including tumor diameter and total operation time, between both groups. The postoperative hospital stay was significantly shorter for the SPLS group than for the laparotomy group (median, 2 [1 to 5] vs. 4 [3 to 17] days; P<0.001). The number of postoperative general diet build-up days was also significantly shorter for the SPLS group (median, 1 [1 to 4] vs. 3 [2 to 16] days; P<0.001). Immediate post-operative pain score was lower in the SPLS group (median, 2.0 [0 to 8] vs. 4.0 [0 to 8]; P=0.045). Patient-controlled anesthesia was used less in the SPLS group (61.9% vs. 100%). Conclusion SPLS was successful in removing most large ovarian tumors without rupture and showed quicker recovery and less immediate post-operative pain in comparison to laparotomy. SPLS using SW Kim`s technique could be a feasible solution to removing huge ovarian tumors.

Film Session Q&A 2 : 05 ; How to remove a huge ovarian tumor in single port laparoscopic surgery using XXXL endopouch

( Jin Hwa Lee ),( Ga Won Yim ),( Eun Ji Nam ),( Sung Hoon Kim ),( Young Tae Kim ),( Sang Wun Kim ) 대한산부인과학회 2014 대한산부인과학회 학술대회 Vol.100 No.-

목적: Demonstrate a new instrument, technique or procedure 방법: In this video, we showed how to remove huge ovarian tumors in sinlgel port laparoscopic surgery by SW KIM`s method. SW KIM`s method is the technique to put a huge ovarian tumor into a specially designed extremely large endopouch (XXXL: 30x30㎠sized) using two conventional laparoscopic needle holders and one laparoscopic grasper and gravity by changing the patient`s position. After identifying the infundibulopelvic and uteroovarian ligaments salpingooophorectomy including huge ovarian tumor was performed by LigaSure. And then ovarian tumor was located in the pelvic cavity by changing the patient`s position into reverse-trendelenberg position and a XXXL endopouch was inserted and un-rolled inside the abdominal cavity. To insert a huge tumor into the XXXL endopouch, the endopouch was opened in triangular shape. Bilateral apex of baseline of trianglular opening of the endopouch was hold by two needle holders and then the upper apex was hold by a grasper. After holding three point of endopouch opeing, the patient`s position was changed into deep trendelenberg postion, then the tumor came into the endopouch by gravity. While changing the patient`s position, 2 needle holders and a graspers were moved into the pelvic cavity from the abdominal cavity. Aftere identifying the tumor inside the endopouch, tumors could be removed through the single port opening site or transvaginally in laparoscopic hysterectomy case without spillage of ovarian tumor. 결과: The advantage of SW KIM`s method is to remove ovarian tumor without spillage in a single port laparoscopic surgery by putting it into the large endoscopic bag despite narrow space. 결론: Using a specially designed 30×30 cm sized XXXL Endopouch and SW Kim`s technique, huge ovarian tumors could be removed without spillage in single port laparoscopic surgery.

T1b 병기의 신세포암에서 수술 후 예후를 예측할 수 있는 임상 및 병리학적 인자에 대한 연구

오승용, 김영원, 윤형윤, 서성필, 이상근, 김원태, 윤석중, 이상철, 김원재, 김용준 충북대학교 의과대학 충북대학교 의학연구소 2014 忠北醫大學術誌 Vol.24 No.1

연구목적: T1병기의 국소신세포암(localized clear-cell renal cell carcinoma)은 근치적신적출술이 나 부분신절제술이 표준치료이며 수술 후 타 병기에 비해 양호한 예후를 보인다. 하지만, 많은 수의 환 자에서 추적관찰 중 재발 및 사망이 발생하는데, 이는 T1b 병기에서 더 높게 보고되고 있다. 본 연구 에서는 국소신세포암 중 T1b 병기의 신세포암에서 표준적 치료 후 환자의 예후에 영향을 주는 임상 및 병리학적 인자에 대하여 알아보고자 하였다. 대상 및 방법: 1999년부터 2011년 까지 5개 기관에서 근치적신적출술이나 부분신제술을 시행 받은 3567명의 국소신세포암 환자들 중 병리학적 병기가 T1b로 확진 된 702명을 대상으로 하였다. 이들 환자가 가지는 임상 및 병리학적 특성 [연령, 성별, 고혈압, 당뇨, 비만도, European Cooperative Oncology Group(ECOG) 수행도, 증상유무, 수술방법, 종양크기, 분화도, 조직학적 형태 등]을 이용 하여 환자의 예후 [무재발생존율(relapse-free survival), 암특이생존율(cancer-specific survival) 및 전체생존율(overall survival)]에 영향을 미치는 인자에 대하여 다양한 방법으로 비교분석 하였다. 결과: 추적 관찰 기간은 34.0개월 (중앙값, 0-152개월)이었으며, 이 기간 중 재발, 사망 및 암특이사 망은 각각 72례 (10.3%), 57례 (8.1%) 및 24례 (3.4%)에서 발생하였다. 단변량 및 다변량 Cox 비례위험회귀분석에서 다양한 인자들이 무재발생존율(당뇨 유무, 종양크기 및 Fuhrman등급), 암특이 생존율(나이, 체질량지수, 당뇨 유무, 종양크기) 및 전체생존율(나이, 체질량지수, ECOG 수행도, 종 양크기)에 영향을 줄 수 있는 독립적 예후인자였다. 결론: 본 연구결과 국소신세포암의 예후를 예측할 수 있는 다양한 임상 및 병리학적 인자를 확인 할 수 있었다. 이러한 위험인자를 가지고 있는 환자는 보다 적극적인 추적관찰을 통하여 재발을 조기에 발 견한다면 이들의 생존율 향상에 많은 기여를 할 수 있을 것으로 생각한다.

진성 복압성 요실금 환자에서 복강경하 방광경부현수술의 유용성: 타술식과의 비교 연구

김용태,엄민식,이석영,신관희,서정원,윤석중,이상철,김원재 충북대학교 의학연구소 2001 忠北醫大學術誌 Vol.11 No.2

연구목적: 진성 복압성 요실금의 치료법으로서 복강경을 이용한 Burch 수술을 타수술법과 비교하여 그 유용성을 알아보고자 하였다. 대상 및 방법: 진성 복압성 요실금을 주소로 본원 비뇨기과에서 수술을 시행받은 44명의 환자를 수술법별로 분류하여 수술법에 따른 성공률, 수술 시간, 입원 기간 및 합병증의 빈도를 비교 분석 하였다. 결과: 전체 환자에서 수술 성공률은 86.4% 였으며 이들 중 복강경을 이용한 Burch 수술군에서는 성공률이 100% 이었다. 복강경을 이용한 Burch 수술군은 타수술군에 비하여 입원 기간이 짧았다. 복강경을 이용한 Burch 수술군은 합병증이 매우 경미하였으며 전체 환자의 31.8%에서 단기간의 배뇨곤란을 호소하였으나 장기간의 배뇨곤란은 없었으며 슬링 수술군에서는 3례(16.7%)에서 심한 절박성 요실금을 호소하였다. 결론: 복강경을 이용한 Burch 수술은 높은 치료 성공률과 낮은 합병증의 빈도를 나타내어 진성 복압성 요실금의 치료에서 매우 우수한 수술법으로 사료된다. Purpose: We performed this study to investigate the usefulness of laparoscopic Burch colposuspension as a treatment of genuine stress incontinence compare to other anti-incontinence operation. Materials and Methods : We analyzed success rate, operation time, admission day, and complication rate of various anti-incontinence operations in 44 genuine stress incontinence patients who have been received operation in our hospital. Results : Overall success rate was 86.4%, but laparoscopic Burch coposuspension showed 100% success rate. Laparoscopic Burch colposuspension required shorter admission day compared to other anti-incontinence oparations. Complication rate was lower in laparoscopic Burch colposuspension group. Short-term voiding problems were identified in 31.8% of total patients but 3 patients(16.7%) who have received sling operation complained severe urge incontinence. Conclusion : Laparoscopic Burch colposuspension is considered as an effective surgical method for genuine stress incontinence due to high success rate and low complication rate.

인체 방광암에서 p33^ING1의 발현 변화

이석영,신관희,한광희,이상철,김용태,김원재 大韓泌尿器科學會 2001 Korean Journal of Urology Vol.42 No.7

요석 환자에서 대사 이상의 평가

이석영,서정원,윤석중,이상철,김용태,김원재 충북대학교 의학연구소 2001 忠北醫大學術誌 Vol.11 No.2

연구목적: 요석은 대사적 질환의 일종이라 할 수 있으며 이는 소변의 유체 역학의 장애나 혹은 배설되는 대사 산물의 생화학적 불균형으로 초래하게 된다. 따라서 본 연구에서는 24시간 요검사를 통하여 요석 환자들에서 요중 대사적 이상에 대해 알아보고자 하였다. 대상 및 방법: 연속적으로 내원한 재발성 요석 환자 151명(남자 114명, 여자 37명)을 대상으로 하였으며, 요석이 완전 치유된 후 최소 3개월이 지나고 24시간 소변을 채취하여 요량, 나트륨, 인, 요산, 칼슘, 마그네슘, 수산 및 구연산에 대하여 분석하였으며 대사 이상의 종류 및 빈도를 조사하였다. 결과: 요석 환자들에서 가장 호발하는 대사적 이상은 저구연산뇨증(47.1%)이었으며 다음으로 고나트륨뇨증(43.2%), 저소변량(30.5%), 고칼슘뇨증(23.5%), 고요산뇨증(22.1%), 고수산뇨증(10.7%), 그리고 저마그네슘뇨증(9.4%) 순이었다. 151명의 환자 중 적어도 한가지 이상의 대사 이상이 136명에서 관찰되었다. 결론: 요석 환자들에서 요중 대사 이상은 90.1%에서 관찰되었으며 저구연산뇨증과 고나트륨뇨증이 요석의 생성과 재발에 중요한 역할을 하는 것으로 조사되었다. 이러한 요중대사적 평가는 요석 환자의 진단 및 예방에 유용하게 이용될 수 있을 것으로 사료된다. Purpose: Urolithiasis is a metabolic disease which arises from disturbances of the physico-chemical balance or the hydrodynamic system of the urine. This study was to determine the metabolic abnormalities through the 24-hour urine examination in patients with urolithiasis. Materials and Methods: The 24-hour urine specimens of 151 RSF (114 men, 37 women) were analyzed for volume, sodium, phosphorus, uric acid, calcium, magnesium, oxalate, and citrate. The incidence and frequency of metabolic abnomalities in RSF were determined. Results : The most frequent metabolic abnormality in RSF was hypocitraturia (47.1% ), followed by hypernatriuria (43.2%), low urine volume (30.5% ), hypercalciuria (23.5%), hperuricosuria (22.1%), hyperoxaluria (10.7%), and hypomagnesiuria (9.4%). At least one metabolic abnormality was found in 136 out of 151 RSF. Conclusion : Our results showed that RSF had metabolic abnormalities were found up to 90.1% of them. Hypocitraturla and hypernatriuria could play an important role in the development and recurrence of urolithiasis. This data suggested that metabolic evaluation might be the useful tools for urolithiasis detection and prevention.

8-hydroxyguanine이 전립선비대증 발생에 미치는 효과

이재원,이석영,이형래,이상철,김용태,김원재 충북대학교 의학연구소 2002 忠北醫大學術誌 Vol.12 No.2

연구목적: 전립선비대증은 노화현상에 의해 발생하는 질환으로서 임상적으로 주로 50세 이상에서 증상이 나타난다. 산소 라디칼은 DNA의 염기에 다양한 손상을 미칠 수 있다. 산소 라디칼에 의한 DNA의 변화에는 여러 가지 형태가 있으며 이러한 변화들 가운데서 guanine이 8-oxoguanine (8-hydroxyguanine, oh8Gua)으로의 수산화(hydroxylation) 반응은 가장 흔히 관찰되는 형태로서 노화 및 만성 퇴행성 질환, 기타 여러 질환의 중요한 병인으로 인식되고 있다. 세포에 유해한 영향을 주는 oh8Gua의 생성으로부터 유전자를 보호하는 수복효소 중 8-oxoguanine-DNA glycosylase (OGG1)가 주된 역할을 하는 것으로 알려져 있는데 이 효소를 생산하는 유전자인 hOGG1은 사람마다 유전자형이 다르다. 따라서 본 연구에서는 전립선비대증이 노화와 관련된 hOGG1 유전자형에 따라서 발생에 차이가 있는지를 조사하였다. 대상 및 방법: 충북대학교 병원에서 전립선비대증으로 진단 받고 입원하여 경요도전립선절제술을 받은 환자로 병리 조직학적으로 전립선비대증이 확인된 81명을 환자군으로 하였으며, 충청북도내 10개 군에서 50세 이상의 건강한 성인 남자 764명을 대상으로 실시한 전립선 무료검진에서 경직장 초음파 검사상 전립선 크기 20 gm 이하, 국제 전립선 증상 점수(IPSS) 7점 이하, 요속 10 ㎖/s 이상, 전립선 특이 항원(PSA) 4.0 ng/㎖ 이하인 81명을 대조군으로 설정하였다. 이들에서 채취한 혈액에서 genomic DNA를 얻은 후 PCR-SSCP (polymerase chain reaction-single stranded conformation polymorphism), 직접 염기서열분석(direct DNA sequencing) 및 RFLP (restriction fragment length polymorphism)를 통해서 두 군 사이의 hOGG1 유전자의 다형성을 분석하였다. 결과: 대조군에서 codon 326형은 Ser326Ser형이 12례(14.8%), Ser326Cys형이 51례(63.0%), Cys326Cys형이 18례(22.2%)였으며 전립선비대증 환자군에서는 Ser326Ser형이 15례(18.5%), Ser326Cys형이 34례(42.0%), Cys326Cys형이 32례(39.5%)로 두 군 사이에 통계적인 유의성이 관찰되었다(p=0.022). 또한 Cys326Cys형과 나머지(Ser326Ser, Ser326Cys)형으로 나누어 시행한 통계 분석에서도 대조군에서는 각각 18례(22.2%), 63례(77.8%)였으며 전립선비대증 환자군에서는 32례(39.5%), 49례(60.5%)로 통계적인 유의성이 관찰되었다(p=0.017, OR=2.286, 95% CI=1.149-4.546). 결론: hOGG1 유전자의 형태와 전립선비대증의 발생과는 밀접한 관련이 있었다. 즉 hOGG1 Cys326Cys형을 가진 사람에서 전립선비대증이 발생한 가능성이 높을 것으로 사료된다. Purpose: 8-oxoguanine DNA glycosylase (OSS1) rapairs DNA by removing 8-oxoguanine (oh8Gua), a highly mutagenic oxidative DNA adduct. Recently, the human gene for OGG1 (hOGG1) was cloned and several genotypes have been reported. However, the implications of such genotypes in benign prostatic lyperplasia have not been demonstrated. To assess the involvement of hOGG1 associated with the aging process on the developing of BPH, we analyzed the genetic polymorphisms of hOGG1. Materials and Methods: We studied the hOGG1 gene polymorphisms in 81 cases of BPH and 81 cases of normal controls. We performed the SSCP, PCR-based restriction fragment length polymorphism (RFLP) and direct sequencing to characterize the genetic polymorphisms of hOGG1 in both BPH patients and controls. Results: We found two polymorphic sites. A serine326/cysteine polymorphism at codon 326 (1a type) in exon 7 was associated with an exchange of amino acid. Another polymorphic site at codon 324 (1b type) in exon 6 was silent. We found that the distribution of hOGG1 genotypes in BPH patients (Ser326Ser type 18.5%, Ser326Cys type 42.0% and Cys326Cys type 39.5%) was significantly different from that in controls (14.8%, 63.0% and 22.2%, respectively) (p=0.022). Homozygosity for the Cys326Cys genotype significantly increased the risk of developing BPH, with the odds ratio (OR) being 2.286 (95% confidence interval [CI]=1.149-4.546) Conclusion: Our results suggest that the hOGG1 Cys326Cys genotype might play a important role in the development of BPH.

Expression of programmed cell death ligand 1 and immune checkpoint markers in residual tumors after neoadjuvant chemotherapy for advanced high-grade serous ovarian cancer

Kim, Hyun-Soo,Kim, Ji-Ye,Lee, Yong Jae,Kim, So Hee,Lee, Jung-Yun,Nam, Eun Ji,Kim, Sunghoon,Kim, Sang Wun,Kim, Young Tae Elsevier 2018 Gynecologic oncology Vol.151 No.3

<P><B>Abstract</B></P> <P><B>Objective</B></P> <P>To investigate the prognostic value of the expressions of programmed cell death ligand 1 (PD-L1) and immune checkpoint markers in residual tumors after neoadjuvant chemotherapy (NAC) for advanced high-grade serous ovarian cancer (HGSOC).</P> <P><B>Methods</B></P> <P>We collected pre- and post-NAC tumor samples from patients with advanced HGSOC between 2006 and 2017. Post-NAC tumor tissue samples were available for immunostaining from 131 patients. The expressions of PD-L1 and immune checkpoint markers were assessed by immunohistochemical staining and the status of tumor-infiltrating lymphocytes (TILs) was also evaluated. We examined whether there are significant associations between protein expression status and patient outcomes and whether significant changes in protein expression levels occurred in response to NAC.</P> <P><B>Results</B></P> <P>PD-L1 expression in the tumor cells was evaluated in 113 patients, 12 (10.6%) of whom had high PD-L1 expression (≥25%) in post-NAC tissues. However, these high levels were not associated with progression-free survival (PFS; P = 0.348) or overall survival (OS; P = 0.699). Similarly, high stromal TILs [≥50%; n = 16 (15.0%)] among the 107 patients evaluated did not show any significant impact on PFS (P = 0.250) or OS (P = 0.800). Moreover, an abundance of TILs (intraepithelial, CD8+, and Foxp3+) and the expression of immune checkpoint markers (PD-1, ICOS, and LAG-3) in residual tumors did not confer any significant survival benefit. The impact of NAC on PD-L1 expression and stromal TILs varied considerably among individual patients.</P> <P><B>Conclusion</B></P> <P>Although the expression of PD-L1 and immune checkpoint markers in residual tumors after NAC had no prognostic impact on survival in patients with HGSOC, post-NAC evaluation of these proteins in chemoresistant tumors may help select patients for immunotherapy trials.</P> <P><B>Highlights</B></P> <P> <UL> <LI> PD-L1 expression and stromal TILs were low in most residual tumors after NAC. </LI> <LI> High expression of immune parameters did not show any significant impact on survival. </LI> <LI> The impact of NAC on immune parameters varied considerably among individual patients. </LI> <LI> This study highlights the importance of evaluating the post-NAC samples to guide adjuvant treatment. </LI> </UL> </P>

Analysis of chromosomal changes in serous ovarian carcinoma using high-resolution array comparative genomic hybridization: Potential predictive markers of chemoresistant disease

Kim, Sang Wun,Kim, Jae Wook,Kim, Young Tae,Kim, Jae Hoon,Kim, Sunghoon,Yoon, Bo Sung,Nam, Eun Ji,Kim, Hye Yeon Wiley Subscription Services, Inc., A Wiley Company 2007 Genes, chromosomes & cancer Vol.46 No.1

<P>The mechanism of drug resistance in cancer is multifactorial, and the accumulation of multiple genetic changes may lead to drug-resistant phenotypes. This study sought to determine characteristic genetic changes in chemoresistant serous ovarian carcinomas using high-resolution array comparative genomic hybridization (aCGH), and identified genomic aberrations that could be used as predictive markers of chemoresistant disease. Seventeen primary ovarian tumors from optimally debulked stage IIIc serous ovarian carcinoma patients were analyzed using aCGH. Ten patients had chemoresistant disease (progression within 12 months of initial chemotherapy), whereas seven patients had chemosensitive disease (no recurrence for more than 36 months). Receiver operating characteristics curve analysis was used to select chromosomal aberrations that could help distinguish chemoresistant disease from chemosensitive disease. In 17 tumors, frequent increases in DNA copy number were seen on 1p36.33, 3q26.2, 8q24.3, 10q26.3, 12p11.21, 20q13.33, and 21q22.3, and frequent losses were observed on 4p12, 5q13.2, 7q11.21, 8p23.1, 14q32.33, Xq13.3, and Xq21.31. The gains on 5p15.33 and 14q11.2, and losses on 4q34.2, 4q35.2, 5q15, 8p21.1, 8p21.2, 11p15.5, 13q14.13, 13q14.2, 13q32.1, 13q34, 16q22.2, 17p11.2, 17p12, and 22q12.3 were more frequent in chemoresistant disease. The losses on 13q32.1 and 8p21.1 had the largest areas under the curve (AUC 0.90 and 0.85, respectively). The most reliable combination of chromosomal aberrations for detecting chemoresistant disease was the loss on 13q32.1 and 8p21.1 (AUC 0.950). Our findings suggest that these chromosomal aberrations are potential predictive markers of chemoresistant disease in patients with serous ovarian carcinomas. © 2006 Wiley-Liss, Inc.</P>

Clinical outcomes of adjuvant radiation therapy and prognostic factors in early stage uterine cervical cancer

Kim, Hyun Ju,Rhee, Woo Joong,Choi, Seo Hee,Nam, Eun Ji,Kim, Sang Wun,Kim, Sunghoon,Kim, Young Tae,Kim, Gwi Eon,Kim, Yong Bae The Korean Society for Radiation Oncology 2015 Radiation Oncology Journal Vol.33 No.2

Purpose: To evaluate the outcomes of adjuvant radiotherapy (RT) and to analyze prognostic factors of survival in the International Federation of Gynecology and Obstetrics (FIGO) IB-IIA uterine cervical cancer. Materials and Methods: We retrospectively reviewed the medical records of 148 patients with FIGO IB-IIA uterine cervical cancer who underwent surgery followed by adjuvant RT at the Yonsei Cancer Center between June 1997 and December 2011. Adjuvant radiotherapy was delivered to the whole pelvis or an extended field with or without brachytherapy. Among all patients, 57 (38.5%) received adjuvant chemotherapy either concurrently or sequentially. To analyze prognostic factors, we assessed clinicopathologic variables and metabolic parameters measured on preoperative 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT). To evaluate the predictive performance of metabolic parameters, receiver operating characteristic curve analysis was used. Overall survival (OS) and disease-free survival (DFS) were analyzed by the Kaplan-Meier method. Results: The median follow-up period was 63.2 months (range, 2.7 to 206.8 months). Locoregional recurrence alone occurred in 6 patients, while distant metastasis was present in 16 patients, including 2 patients with simultaneous regional failure. The 5-year and 10-year OSs were 87.0% and 85.4%, respectively. The 5-year and 10-year DFSs were 83.8% and 82.5%, respectively. In multivariate analysis, pathologic type and tumor size were shown to be significant prognostic factors associated with both DFS and OS. In subset analysis of 40 patients who underwent preoperative PET/CT, total lesion glycolysis was shown to be the most significant prognostic factor among the clinicopathologic variables and metabolic parameters for DFS. Conclusion: Our results demonstrated that adjuvant RT following hysterectomy effectively improves local control. From the subset analysis of preoperative PET/CT, we can consider that metabolic parameters may hold prognostic significance in early uterine cervical cancer patients. More effective systemic treatments might be needed to reduce distant metastasis in these patients.