Single-port laparoscopic transperitoneal infrarenal para-aortic lymphadenectomy as part of staging operation for early ovarian cancer and high grade endometrial cancer

이윤순 대한부인종양학회 2016 Journal of Gynecologic Oncology Vol.27 No.3

Objective: The aim of this paper was to demonstrate the techiniqes of single-portlaparoscopic transperitoneal infrarenal paraaortic lymphadenectomy as part of surgicalstaging procedure in case of early ovarian cancer and high grade endometrial cancer. Methods: After left upper traction of rectosigmoid, a peritoneal incision was made caudadto inferior mesenteric artery. Rectosigmoid was mobilized, and then the avascular space ofthe lateral rectal portion was found by using upward traction of rectosigmoid mesentery. Inframesenteric nodes were removed without injury to the ureter and the left common iliacnodes were easily removed due to the upward traction of the rectosigmoid. The superiorhypogastric plexus was found overlying the aorta and sacral promontory, and presacral nodeswere removed at subaortic area. Peritoneal traction suture to right abdomen was needed forright para-aortic lymphadenectomy. After right lower para-aortic node dissection, operatorwas situated between the patient’s legs. After upper traction of the small bowel, left upperpara-aortic nodes were removed. To prevent chylous ascites, we used hemolock or Ligasureapplication (ValleyLab Inc.) to upper part of infrarenal and aortocaval nodes. Results: Single-port laparoscopic transperitoneal infrarenal para-aortic lymphadenectomywas performed without serious perioperative complications. Conclusion: Even though the technique of single-port surgery is still a difficult operation,the quality of single-port laparoscopic transperitoneal infrarenal para-aortic node dissectionis excellent, especially mean number of para-aortic nodes. In cases of staging procedures forovary and endometrial cancer, single-port transperitoneal para-aortic lymphadenectomy isacceptable as an oncologic procedure.

유암수술후 Tamoxifen 복용중에 발생한 양측장액성낭선종이 동반된 자궁내막암 1례

이윤순,구태본,김성엽,구명숙,정연주,박일수 대한산부인과학회 1993 대한산부인과학회 학술대회 Vol.72 No.-

부인 악성종양에 있어서 내시경수술

이윤순 대한산부인과학회 2002 연수강좌 Vol.31 No.-

난소암 및 자궁경부암 세포주에 있어서 Topotecan 의 시험관내 상호 작용

이윤순,이택후 대한부인종양 콜포스코피학회 2000 Journal of Gynecologic Oncology Vol.11 No.1

Objectives : The aims of this study were to evaluate the interaction of topotecan with adriamycin, etoposide, 5 fluorouracil (5 FU) and mitomycin C in the established four ovarian cancer cell lines and three cervical cancer cell lines and to establish whether the combination of topotecan with other antitumor drugs would be a synergism for chemotherapy in patients with ovarian and cervical cancer. Methods : Five antitumor drugs were tested for synergism and antagonism in combination studies in four ovarian cancer cell lines (A2780, A2780 cisplatin resistant variant, A2780 taxol resistant variant, SKOV3) and three cervical cancer cell lines (HeLa, SiHa, ME180). Cytotoxic effects were determined by MTT assay. Synergic interaction was calculated by the median effect principle in which combination index (CI) of less than one suggest a synergic interaction. Results : Dm value of topotecan against SKOV3 (2.07 ug/ml), HeLa (3.32 ug/ml), SiHa cell lines (2.5 ug/ml) were above peak plasma concentration of topotecan (0.5 ug/ml) but most antitumor drugs tested in combinations index were within clinically relevant range. Combination with topotecan showed a synergic effect (CI$lt;1) in seven cancer cell lines at a intermediate or high level of cytotoxicity especially with mitomycin C (6/7), etoposide (6/7), 5 FU (6/7) and adriamycin (4/7). Most striking findings were that a synergic effect was shown in all ovarian cancer cell lines to topotecan/mitomycin C, topotecan/5 FU and topotecan/esoposide combination showed a synergic effect in all cervical cancer cell lines. Topotecan/adriamycin combination showed synergism at an intermediate or high level of cytotoxicity in cisplatin or Taxol resistant ovarian cancer cell lines (A2780CP, A2780TX, SKOV3). Conclusion : These results suggested that topotecan showed a synergic effect with a wide range of antitumor drugs: adriamycin, etoposide, 5 FU, mitomycin C in ovarian and cervical cancer cell lines. Combinations of topotecan/mitomycin C, topotecan/5 FU and topotecan/adriamycin for ovarian cancer and a combination of topotecan/etoposide for cervical cancer seemed worthy of consideration for clinical application.

Laparoscopic Oncologic Operation in the Gynecologic Cancer

이윤순 대한산부인과학회 2003 교육강연 Vol.2003 No.-

Audio/Visual Session : Completely total Laparoscopic radical hysterectomy with pelvic Lymphadenectomy for early invasive cervical cancer

이윤순 대한산부인과학회 2005 대한산부인과학회 학술대회 Vol.91 No.-

Film Session Q&A : Uterine artery sparing total Laparoscopic radical trachelectomy (초)

이윤순 대한산부인과학회 2010 대한산부인과학회 학술대회 Vol.96 No.-

질식자궁적출술의 임상적 시도

이윤순,유봉재 대한산부인과학회 1995 Obstetrics & Gynecology Science Vol.38 No.10

1993년 3월부터 1994년 7월까지 만 17개월간 경북대학교병원 산부인과에서 골반암을 제외한 환자중 107예에서 자궁적출술을 시행하였으며 그중 100예(93.5%)에서 질식자궁적출술을 시 행하여 비록 17개월의 단기간이지만 질식수술율에 있어서 현재 시행보고된 보고중 가장 높 은율이었고 다음과 같은 결론을 얻었다. 1. 평균 연령은 45.69+-7.80(31-71)세였다. 2. 평균분만경험은 3회였고 질식분만 경험이 없는 경우가 2예, 한 번 질식분만경험이 있는 경우가 8예였다. 3. 자궁이 적출되기까지의 시간은 평균 34.52+-12.80분(11-95), 수술이 마칠때까지의 시간은 74.58+-24.68(35-210)이 걸렸다. 4. 수술전 후 헤모글로빈간에는 유의한 차이가 있었다. 5. 가장 많은 자궁내막조직은 위축기였고 내막조직과 출혈량과의 유의한 차이는 없었다. 6. 수술전 가장 많은 적응증은 자궁근종 (49%), 그다음 CIN II-III(27%, 자궁탈출증(10%), 자궁 선근종(7%), 기능성자궁출혈(5%)순이었다. 7. 평균수술후 입원 일수는 4일이었다. 8. 기왕 수술경력이 46예 환자에 있었다. 9. 자궁적출술에 걸린 평균 시간과 총 수술에 걸린 시간은 자궁분만 방식에 따른 group I인 경우 26.03+-8.39분과 66.86+-19.15분, group II인경우에 36.83+-10.28과 76.49+-29.33분, group III인 경우 42.96+-14.96분과 82.58+-20.49분이였고 자궁적출에 걸린 시간중 III과 I군 사이와 II군과 I 군 사이에서만 유의한 차이가 있었고(p=0.001)총수술시간에 대한 수술방식에 따른 유의한 차이는 없었다. 10. 평균 출혈량은 182.16+-191.89ml (20-1200ml)였고 수술방법과 출혈량에 대해서는 group I 에서 119.94+-84.80ml, group II에서 188.80+-207.15ml, group III에서 261.54+-246.35ml였고 group I과 group III에서만 유의한 출혈량의 차이가 있었다. (p=0.0183) 11. 평균 자궁무게는 195.04+-134.83gm(34-800gm)이였고 수술방법과 자궁무게와의 대해서는 group I에서 87.74+-35.37gm, group II에서는 208.49+-114.78gm, group III에서 328.54+-147.53 gm이였고 수술방법에 따른 자궁무게와 유의한 차이가 있었다(p=0.0001). 12. 가장 많은 동반된 수술은 부속기 절제술 (34%)이었으며, 그 다음 질벽협축술(15%), 대망 절제술(1%), 방광 열상의 일차적 봉합술(1%)이었다. 이상 결론적으로 저침습성 수술인 질식자궁적출술은 술자의 경험에 따라서는 자궁적출술에 서는 93.5%에서 개복수술을 피할 수 있고, 적응증도 더욱확대하여 coring이나 morcellation을 이용하면 총수술시간에 지연이 없고 출혈량에 있어서 70-140ml정도 더 출혈이 있으나 임신 12주이상 크기의 자궁근종도 자궁부피를 줄일수 있는 술기로 쉽게 질식으로 수술이 가능함 에 상대적으로 질식수술이 힘든 경우에도 시행함으로서 환자에게 개복수술에 따르는 심리적 육체적 고통을 경감시킬 수 있고 또 고가 장비인 복강경 기구의 금전적 부담도 줄어 들 수 있는 저침습성 수술이므로 질식수술의 적절한 수련만이 개복수술을 피할 수 있는 방법이라고 사료된다. To evaluate the feasibility, safety, complication and outcomes by the method of operation (group I, II,III) in 100 women undergoing total vaginal hysterectomy at the Department of Obstetrics and Gynecology, College of Medicine, Kyungpook National University Hospital during the period from March 1993 to July 1994. The results obtained were as follows. 1. We performed 100 cases of total vaginal hysterectomy (93.5%) and 7 cases of total abdominal hysterectomy (6.5%) 2. The average age of patients was 45.69+-7.8(31-71) years old and 1 nullipara and 7 primiparas and 92 multiparas. The mean parity was 3. 3. THe average time of hysterectomy and operation was 34.52+-12.80 min(11-95min) and 74.58+-24.68min(35-210 min), respectively. 4. The average time of hysterectomy and operation by the method of removing uterus was 26.03+-8.39 min and 66.86+-19.15 min in group I, 36.83+-10.28 min and 76.49+-29.33 min in group II, 42.96+-14.96 min and 82.58+-20.49 min in group III. there was no statistically significant in operation time but significant between group I and II, group I and III in hysterectomy time (p=0.0001). 5. The mean value of preoperative and postoperative Hb was 12.0g/dl and 11.1g/dl. There was statistically significant between preoperative and postoperative hemoglobin(p=0.0001). 6. The mean blood loss was 182.16+-191.89ml(20-1200ml) and 119.94+-84.80ml in group I, 188.80+-207.15 ml in group II, 261.54+-246.35 ml in group III. There was only statistically significant between group I and group III(p=0.0183). 7. The average weight of uterus was 195.04+-138.83gm(34-800gm), and 87.74+-35.37gm in group I, 208.49+-114.79 gm in group II, 328.54+-147.53 gm in group III. there was statistically significant among 3 groups (p=0.0001). 8. THe most common endometrial histology was atrophy (39%). There was no statistically significant between endometrial histology and blood loss(p=0.0680). 9. The most common andication was myoma(49%), and CIN(27%), prolapse(15%), adenomyosis(7%), DUB(5%), others(2%). 10. The most common associated procedure was adnexectomy(34%) and AP repair(15%), omentectomy (1%) , bladder repair(1%) 11. The minor complication rate was 16% e.g. Hemorrhage required ransfusion(5%) Cuff infection (4%), Bladder distension(3%), URI(2%), Bladder laceration(1%), Explo-laparotomy(1%). 12. The mean hospital days were 4 days(2-29). 13. 46% of operated women had previous abdominal operation. We concluded that 93.5% of hysterectomy can be done via vagina by coring and morcellation without significant complication and without the need of expensive laparoscopic equipments. The rate of vaginal route (93.5%) was the highest among the previous other reports.

미세침윤자궁경암의 세포

이윤순,이태호 대한산부인과학회 1982 대한산부인과학회 학술대회 Vol.49 No.-

A/V Session : Laparoscopic repair of pelvic floor defect -uterine prolapse with cystocele, rectocele - Vault prolapse with cystocele, rectocele

이윤순 대한산부인과학회 2004 교육강연 Vol.2004 No.-