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Robotic hysterectomy as a new trendy surgical procedure for benign uterine disease
( Ryeobin Lee ),( Inji Yeo ),( Soobin Yim ),( Pong Rheem Jang ),( Jeong Bae Kang ),( Hye-yon Cho ),( Min Sun Kyung ) 대한산부인과학회 2018 대한산부인과학회 학술대회 Vol.104 No.-
Objective: This study was aimed to evaluate the safety and feasibility of robotic hysterectomy (RH) for large uterus by comparing surgical outcomes of conventional laparoscopic hysterectomy (LH) to those of RH. Methods: We retrospectively reviewed medical records of 52 patients who underwent RH (N=26) and LH (N=26) from June 2015 to September 2016. Clinical characteristics, surgical outcomes and postoperative NRS scores were compared between the two groups. Results: Mean uterine weight was 374.5 g in RH group and 319.8 g in LH group (P= 0.319). Clinical characteristics, including parity, BMI, prior abdominal surgery, and co-morbidities were not different between the two groups. However, the mean age of women in RH group was significantly younger than those in LH group (P = 0.007). Operative time was significantly longer in RH group than LH group (144.2 25.87 min vs. 104.4 32.56 min, P < 0.0001). Mean estimated blood loss was significantly heavier in LH group than RH group (157.3 39.04 mL vs. 108.1 56.42 mL, P= 0.001). Mean NRS score at postoperative 6 hrs was significantly lower in RH group than LH group (2.7 1.74 vs. 4.5 1.86, P= 0.001). In addition, postoperative return of bowel activity was significantly faster in RH group than LH group (36.0 13.39 hrs vs. 48.9 15.88 hrs, P= 0.003). Conclusion: Our data suggested that RH was correlated with a less blood loss, less postoperative pain, and faster recovery of bowel activity. RH is a safe, feasible, and less painful approach even for large uterus.
Sentinel node detection in early stage cervical cancer
( Chae Chun Rhim ),( Sung Joo Kim ),( Young Han Park ),( Jung Bae Kang ),( Pong Rheem Jang ) 대한산부인과학회 2011 Journal of Womens Medicine Vol.4 No.2
Objective: To investigate the feasibility of sentinel node frozen biopsy to minimize the extensive pelvic lymph nodes dissection in early stage cervical cancer patients on the basis that the risk of skip metastasis to the paraaortic area is negligible. Methods: The 45 patients with early stage cervical cancer were enrolled in this study. Technetium-99 m colloid albumin was injected intradermally around the tumor for allowing preoperative lymphoscintigraphy and intraoperative hand-held gamma probe detection of seninel lymph nodes. For visual detection, isosulfan blue dye was injected into the peritumoral sites before peritoneal opening. Postoperative morbidity and negative predictive value were the endpoints of this study. Results: The 45 patients, ranging in age from 32 to 71 year, underwent intraoperative sentinel nodes mapping. There were 33 benign and 12 malignant cases on frozen biopsy. On permanent histopathological specimen, there were 31 benign and 14 malignant cases. In 31 out of 33 cases determined to be benign on the sentinel node frozen biopsy, there were no pelvic lymph node metastasis on the permanent pathology. In only 2 cases found to be benign on the sentinel node frozen biopsy, there were pelvic lymph node metastasis on the permanent histopathology. These results are statistically significant(P<0.0001).Conclusion: This new technique of sentinel node mapping is safe and simple to perform. Further clinical trials using the combination of Technetium-99 m and isosulfan blue dye are warranted and this technique will make a true advance for lessaggressive management of patients with early stage cervical cancer.
Malignant Perivascular Epithelioid Cell Tumor(PEComa) of the Uterus with Lung Metastasis
( Jeong Bae Kang ),( Jin Won Seo ),( Young Han Park ),( Pong Rheem Jang ) 대한산부인과학회 2014 대한산부인과학회 학술대회 Vol.100 No.-
PEComa is a very rare mesenchymal tumor with an unpredictable natural history arising in a wide array of anatomic locations. PEComas which occur in non-classic anatomic distributions are known as perivascular epithelioid cell tumor-not otherwise specified (PEComa-NOS). Most of them in uterus had abnormal uterine bleeding and palpable mass or pain at the lower abdomen, which was similar with the symptoms and signs of other uterine tumors. These tumors are characterized by epithelioid to spindle cells with eosinophilic to clear cytoplasm, an intimate relationship with blood vessels, and demonstrate positive immunostaining for markers of both melanocytic (HMB45, Melan-A, tyrosinase) and myoid (desmin, smooth muscle actin, muscle-specific actin, caldesmon, calponin) differentiation. Currently, surgery is the mainstay of treatment. Although radiotherapy, chemotherapy or immunotherapy is being implemented for treatment of malignant PEComa after surgery, the effect of this adjuvant treatment do not well established yet. About 150 PEComas-NOS have been reported in the English published reports, of which 38 were uterine PEComas. These 28 reported cases of uterine PEComas have usually shown clinically benign behavior, but 10 tumors exhibited locally aggressive behavior. Four of these ten locally aggressive uterine PEComa-NOS showed distant metastasis to liver, lungs, intestines, bone and lymph nodes. Here we report a very rare malignant uterine PEComa of a 49-year-old unmarried woman with lung metastasis despite adjuvant chemotherapy after initial surgery.
변형된 Shirodkar법을 이용한 양막탈출을 동반한 자궁경부 무력증의 처치 2 예
이지영(Ji Young Lee),박찬우(Chan Woo Park),장봉림(Pong Rheem Jang),박양서(Yang Suh Park),김유곤(You Kon Kim),윤태숙(Tae Suk Yoon) 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.12
Two patients, bulging fetal membrane accompanied with cervical dilatation & effacement in the late second-trimester, were treated by modified Shirodkar method. Pregnancies were prolonged effectively and viable fetuses were delivered in both cases. Our cases may help make objective decision prior to attempting cerclage placement when cervix is markedly dilated and something should be done to save pregnancy.
자궁경부암에서 Cyclooxygenase - 2 의 발현과 혈관신생
민봉식(Bong Sik Min),손우석(Woo Seok Sohn),장기택(Kee Taek Jang),이성원(Sung Won Lee),김홍배(Hong Bai Kim),이용우(Yong Woo Lee),강성원(Sung Won Kang),박양서(Yang Suh Park),장봉림(Pong Rheem Jang) 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.3
Objective: A large body of evidence suggests that cyclooxygenase-2 (COX-2) is important in tumor growth and angiogenesis of gastrointestinal and other cancers. This was the study to determine the relationship between tumor vascularity and COX-2 expression in invasive cervical cancer. Methods: We examined the expression of COX-2 and microvessel density (MVD) by immunohistochemical staining in 21 specimens collected from invasive cervical cancer patients. Results: All specimens showed weak and strong immunoreactivity, with 52.4%strong reactivity. Microvessel count was higher (median 136) in the strong COX-2 immunoreactivity specimens than the weaks (median 90),and MVD was significantly correlated with the COX-2 immunoreactivity (P=0.002). Conclusion: These preliminary data indicate that overexpression of COX-2 may play an important role in carcinogenesis of cervical cancer and this could be partially attributable to modulation of angiogenesis by COX-2.COX-2 maybe a target for future research in the tumorigenesis of the invasive cervical cancer.