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Hye-yon Cho,1 Sung-taek Park,2 Sung-ho Park,2 Min Sun Kyung1 1Department of Obstetrics & Gynecology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea; 2Department of Obstetrics & Gynecology, Hallym University Gangnam Sacred Heart Hospital, Seoul, KoreaCorrespondence: Min Sun KyungDepartment of Obstetrics and Gynecology, Hallym University Medical Center, 40 Seoku-dong, Hwaseong, 18450, KoreaTel +82-31-8086-2898Fax +82-31-8086-2650Email msfeel@hallym.or.krPurpose: To investigate whether laparoscopic ovarian cystectomy (LOC) affects ovarian reserve.Patients and Methods: In 46 premenopausal women, who underwent either LOC (study group, n=26) or laparoscopic myomectomy (LM) (control group, n=20), serum anti-Mullerian hormone (AMH) levels were measured pre-operatively (AMH0), and postoperatively at 7 days (AMH1), 2 months (AMH2), and 6 months (AMH3). Changes in AMH from baseline level (AMH0) in each group were compared.Results: AMH0 did not differ between the two groups (3.5 ± 3.33 in LOC vs 2.4 ± 2.72 in LM, P=0.250). AMH1, AMH2, and AMH3 in each group were also similar. However, a significant decline of AMH (ie more than 50% decrease compared to AMH0) at postoperative 6 months occurred more frequently in the LOC group than in the LM group. In the sub-analysis of the LOC group, a significant decline of AMH at postoperative 2 months and 6 months was highly correlated with bilateral ovarian tumors (P=0.001).Conclusion: Compared to LM, serum AMH level showed a minimal decrease after 1 week following LOC, which did not revert to normal over 6 months of follow-up. In addition, a significant decline of ovarian reserve at postoperative 6 months was significantly more frequent in the LOC group, suggesting that LOC may have more adverse effects on ovarian reserve compared to the LM (control) group. Thus, care is required during the LOC procedure, specifically in women with bilateral tumors.Keywords: AMH, laparoscopy, ovarian cystectomy, ovarian reserve, electrocautery

Background: Laparoscopy is becoming common for the management of complex benign gynaecological diseases, in which considerable adhesions are expected, thus making the laparoscopic surgery more difficult to perform. Aims: To evaluate the efficacy and safety of laparoscopic surgery for adnexal tumours in post-hysterectomy women. Methods: In a retrospective study, we reviewed and analysed 40 post-hysterectomy women who were treated surgically for benign ovarian tumours at Kangbuk Samsung Hospital, from May 1999 to April 2007. Twenty women received laparotomic surgery and 20 were treated by laparoscopic surgery. Operating time, haemoglobin changes, complication rates, return of bowel activity, and duration of hospital stay were evaluated. Results: Operating time, haemoglobin changes, and complication rates were similar for both groups. For the laparoscopy group, the return of bowel activity was significantly faster (33 vs 45 h; P = 0.0131) and hospital stay was significantly shorter (four vs eight days; P = 0.0005) than for the laparotomy group. Conclusions: Laparoscopic surgery for adnexal tumours in post-hysterectomy women might be an effective and safe alternative to laparotomic surgery. Surgical experience in this procedure and a thorough understanding of retroperitoneal anatomy from a laparoscopic view are mandatory to ensure low morbidity. [ABSTRACT FROM AUTHOR]

Background: Several studies reported that pathology of the appendix is frequently detected alongside endometriosis, especially with chronic pelvic pain. Furthermore, ovarian endometriosis is a marker of more extensive pelvic and intestinal disease. Aims: To evaluate the feasibility and efficacy of incidental appendectomy in laparoscopic surgical treatment for ovarian endometrioma. Methods: One hundred and six women with ovarian endometrioma underwent laparoscopic surgery including laparoscopic appendectomy. Clinicopathological data were collected and analysed. Results: The main symptoms consisted of lower abdominal pain in 51 (48.1%) women, dysmenorrhoea in 23 (21.7%), left lower quadrant pain in 6 (5.7%), right lower quadrant pain in nine (8.5%), chronic pelvic pain in five (4.7%), and others in 12 (11.3%). Only three (3.3%) of the 106 women had abnormal findings on gross inspection during laparoscopic surgery: two women with endometriotic spots on the surface of their appendixes, and one with peri-appendiceal inflammation with severe adhesions. Of the 106 resected appendixes, 37 (34.9%) had histopathologically confirmed pathology including lymphoid hyperplasia in 12 (11.3%), endometriosis in 14 (13.2%), peri-appendicitis and serositis in five (4.7%), carcinoid tumour in three (2.8%), and others in three (2.8%). Conclusions: In all surgical treatments for ovarian endometrioma, surgeons need to preoperatively inform the patients of the fact that appendiceal pathology including endometriosis is found frequently regardless of concurrent symptoms or gross finding of the appendix. Furthermore, surgeons should take into account the possibility of appendiceal pathology during operation. [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate the incidence and risk factors of adnexal torsion (AT) in the Korean population from 2009 to 2018 (10 years)., Methods: We analyzed the 2009-2018 data obtained from the Health Insurance Review and Assessment Service National Inpatient Sample (HIRA-NIS) database. AT was identified by both diagnosis codes and surgery codes of adnexal surgery., Results: A total of 6,262,910 women were recorded in the database. The incidence of AT was 6 per 100,000 women (95% confidence interval (CI), 6-6). The incidence of AT tended to decrease with age after peaking in the late 20s to early 30s. In the weighted logistic regression analysis, women of childbearing age, especially in their 20s and 30s, had the highest AT incidence. Corpus luteal cyst ( p < 0.001) and benign neoplasm ( p < 0.001) increased the incidence of AT. Low socioeconomic status (SES), Charlson comorbidity index (CCI), and pregnancy were unrelated to AT., Conclusion: The incidence of AT is 6 per 100,000 women and peaks in the 20s to early 30s.

This prospective study aimed to investigate the impact of laparoscopic hysterectomy (LH) and laparoscopic myomectomy (LM) on ovarian reserve by comparing serum anti-Mullerian hormone (AMH) changes following surgery. Serum AMH levels were measured preoperatively (AMH0), and 7 days (AMH1), 2 months (AMH2), and 6 months (AMH3) after LH and LM in 79 premenopausal women (LH = 59; LM = 20). AMH0, AMH1, AMH2, and AMH3 were significantly higher in the LM group than in the LH group ( p = 0.012, 0.001, 0.001, and 0.015, respectively). Since there are differences in indications between myomectomy and hysterectomy, logically, women who underwent myomectomy were younger and had higher AMH baseline levels. In addition, AMH changes at 7 days postoperatively from the baseline level were significantly decreased in the LH group compared to those in the LM group ( p = 0.042). However, AMH changes at 2 months and 6 months postoperatively, compared to the baseline level, were not different between the two groups ( p = 0.053 and 0.752, respectively). Moreover, the significant decrease in AMH (more than 60% decrease from the baseline level) was not different at 7 days, 2 months, and 6 months postoperatively between the two groups ( p = 0.415, 487, and 0.364, respectively). Our data suggest that serum AMH levels were significantly decreased directly after LH, which suggests that LH may have adverse effects on ovarian reserve. However, mid-term follow-up showed that the damaged ovarian reserve in women who underwent LH may be partially restored in 6 months.

Colposcopy is widely used to detect cervical cancers, but experienced physicians who are needed for an accurate diagnosis are lacking in developing countries. Artificial intelligence (AI) has been recently used in computer-aided diagnosis showing remarkable promise. In this study, we developed and validated deep learning models to automatically classify cervical neoplasms on colposcopic photographs. Pre-trained convolutional neural networks were fine-tuned for two grading systems: the cervical intraepithelial neoplasia (CIN) system and the lower anogenital squamous terminology (LAST) system. The multi-class classification accuracies of the networks for the CIN system in the test dataset were 48.6 ± 1.3% by Inception-Resnet-v2 and 51.7 ± 5.2% by Resnet-152. The accuracies for the LAST system were 71.8 ± 1.8% and 74.7 ± 1.8%, respectively. The area under the curve (AUC) for discriminating high-risk lesions from low-risk lesions by Resnet-152 was 0.781 ± 0.020 for the CIN system and 0.708 ± 0.024 for the LAST system. The lesions requiring biopsy were also detected efficiently (AUC, 0.947 ± 0.030 by Resnet-152), and presented meaningfully on attention maps. These results may indicate the potential of the application of AI for automated reading of colposcopic photographs.

Background: Although appropriate dietary adjustments in hemodialysis (HD) patients are important, most HD patients have difficulty adhering to dietary therapy due to the stress of a restricted-food diet or loss of appetite, which eventually leads to malnutrition and other complications. The dietary intake of HD patients stratified by nutritional status has not yet been studied., Methods: In total, 111 HD patients from five dialysis centers were stratified into 2 groups based on the Subjective Global Assessment: the well-nourished group and the poorly nourished group. The 7-day dietary intake and food behaviors of the two groups were compared. Logistic regression analysis was performed to reveal the factors associated with poorly nourished status., Results: The 7-day dietary survey showed a lower intake of total calories and protein and a higher intake of sodium and potassium than in the standard recommendations, but there were no differences between groups. The poorly nourished group ate fried food significantly more frequently than the well-nourished group. Moreover, higher hip and waist circumferences were significantly associated with poorly nourished status.

Background: Nutritional factors are associated with high mortality and morbidity in dialysis patients, and protein-energy wasting is regarded as an important one. The modality of dialysis may affect patients' dietary behavior and nutritional status, but no study has compared the dietary behavior, nutrient intake, and nutritional adequacy of hemodialysis (HD) and peritoneal dialysis (PD) patients., Methods: From December 2016 to May 2017, a dietary behavior survey and Semi-quantitative Food Frequency Questionnaire (Semi-FFQ) were conducted on 30 HD patients and 30 PD patients in Ewha Womans University Mokdong Hospital, and laboratory parameters were obtained. The results of prevalent HD and PD patients were then compared., Results: The mean age of HD patients was higher than that of PD patients; HD: 58.5 ± 9.1 years, PD: 49.3 ± 9.7 years (p = 0.001). In the dietary behavior survey, HD patients showed more appropriate dietary behavior patterns overall than PD patients. In the dietary intake analysis with the Semi-FFQ, energy intake was significantly lower in the PD group than in the HD group due to the lower intake of carbohydrates, fat, and protein. A comparison of nutrient intake-to-recommended allowance ratio between the HD and PD groups revealed that the HD group showed higher nutrient intake than the PD group. Serum albumin and potassium levels were significantly higher in HD than in PD patients., Conclusion: According to this study, the dietary behavior and nutritional intake of prevalent PD patients were worse than those of HD patients.

BACKGROUND This study evaluated the performance of serum CYFRA 21-1 and placental growth factor (PIGF) as screening markers for endometriosis. MATERIAL AND METHODS In this prospective study included 81 female patients who underwent laparoscopy to treat benign ovarian tumors. Serum samples were obtained from all study patients before surgery. Serum marker levels, including CYFRA 21-1, PIGF, cancer antigen (CA)125, CA19-9, and human epididymis protein 4 (HE4) were measured using a fluorescence immunoassay technique. RESULTS Forty of the patients were diagnosed with endometriosis (the study group) and 41 women were diagnosed with other benign ovarian tumors (the control group). Mean serum CYFRA 21-1 and PIGF levels were not different between these 2 groups (P=0.179 and P=0.865, respectively). Elevated serum CA125 levels (>35 U/mL) and lower CYFRA 21-1 levels (≤2.29 ng/mL) were more frequently observed in the endometriosis study group than in the control group (P<0.0001, and P=048, respectively). High serum PIGF levels (>14.2 pg/mL) were observed in both groups (P=0.226). Mean serum CA19-9 levels and HE4 levels, as well as the ROMA (risk of ovarian malignancy Algorithm) score were similar between the 2 groups. Sensitivity (95.0%) and negative predictive value (NPV) (80.0%) of CYFRA 21-1 for diagnosing endometriosis were higher than those of CA125 (sensitivity 67.5%, NPV 74.5%) and PIGF (sensitivity 20.0%, NPV 53.6%). However, the specificity (PIGF 90.2%, CA125 92.7%) and positive predictive value (PPV) (PIGF 66.7%, CA125 87.1%) of PIGF and CA125 for diagnosing endometriosis were higher than those of CYFRA 21-1 (specificity 19.5%, PPV 53.5%). CONCLUSIONS CYFRA 21-1 and PIGF may be promising markers to identify patients with and without ovarian endometriosis.

Background: Screening test using CA-125 is the most common test for detecting ovarian cancer. However, the level of CA-125 is diverse by variable condition other than ovarian cancer. It has led to misdiagnosis of ovarian cancer., Methods: In this paper, we explore the 16 serum biomarker for finding alternative biomarker combination to reduce misdiagnosis. For experiment, we use the serum samples that contain 101 cancer and 92 healthy samples. We perform two major tasks: Marker selection and Classification. For optimal marker selection, we use genetic algorithm, random forest, T-test and logistic regression. For classification, we compare linear discriminative analysis, K-nearest neighbor and logistic regression., Results: The final results show that the logistic regression gives high performance for both tasks, and HE4-ELISA, PDGF-AA, Prolactin, TTR is the best biomarker combination for detecting ovarian cancer., Conclusions: We find the combination which contains TTR and Prolactin gives high performance for cancer detection. Early detection of ovarian cancer can reduce high mortality rates. Finding a combination of multiple biomarkers for diagnostic tests with high sensitivity and specificity is very important.

Objectives: To evaluate changes of ovarian reserve after hysterectomy by comparing serum anti-Mullerian hormone (AMH) levels following laparoscopic hysterectomy (LH) to those of non-laparoscopic hysterectomy (non-LH)., Methods: Prospectively, serum AMH levels were measured pre-operatively (AMH0), 7days (AMH1), 2 months (AMH2), and 6 months (AMH3) after LH (total laparoscopic hysterectomy or laparoscopy-assisted vaginal hysterectomy) and non-LH (vaginal hysterectomy or abdominal hysterectomy) in 91 premenopausal women (LH=60, non-LH=31). Changes of serum AMH levels were compared between the two groups., Results: AMH0 was similar between the two groups (P=0.400). Also, AMH1, AMH2, and AMH3 were not different between the two groups (P=0.333, 0.534, and 0.726). A significant decrease of serum AMH level (30% decreases from AMH0) at 7days, 2 months, and 6 months was observed in 44.4%, 34.8%, and 40% of all patients. Interestingly, the incidence of a significant decrease of serum AMH levels at postoperative 2 months was considerably higher in LH group compare to non-LH group (43.9% vs. 20.0%, P=0.042). Multivariate analysis revealed that laparoscopic hysterectomy was an independent risk factor for the significant decrease of serum AMH at postoperative 2 months (Hazard ratio 4.147, 95% confidence interval 1.139-15.097)., Conclusion: Laparoscopic hysterectomy, which is associated with electro-thermal vessel ligation, might have negative effect on ovarian reserve after surgery. More large-scaled, long-term follow-up study is required., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Benzophenone (BP) and its derivatives are widely used in various cosmetics, personal care products, and food packaging ink. The use of BP has raised concerns about the potential health risks associated with its endocrine-disrupting effects. This study evaluated urinary concentrations of BP derivatives in a national sample of the South Koreans population aged 6-89 years. From July to September in each 2010 and 2011, 1576 urine samples were collected. Urinary concentrations of benzophenone-1 (BP-1), benzophenone-2 (BP-2), benzophenone-3 (BP-3), benzophenone-4 (BP-4), benzophenone-8 (BP-8), and 4-hydroxybenzophenone (4-OH-BP) were analyzed using liquid chromatography-mass spectrometry. The detection rate for BP-1 and 4-OH-BP were 56% [limit of detection (LOD) 0.59ng/mL] and 88% (LOD 0.04ng/mL), respectively, whereas those for BP-2, BP-3, BP-4, and BP-8 were all below 25%. The geometric means of urinary BP-1 and 4-OH-BP concentrations were 1.24ng/mL and 0.45ng/mL, respectively. Multiple linear regression analysis indicated that concentrations of BP-1 in and of 4-OH-BP in adults were associated with sex and age. The BP-1 and 4-OH-BP concentration of children and adolescents was associated with sex, age, income, and current area of residence. The correlation was observed between urinary concentrations of BP derivatives, which is an important indication of exposure biomarkers and the metabolic pathways from BP-3. This is the first national study to evaluate the presence of BP derivatives in urine samples from the South Korean population, stratified by demographic factors., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Parabens are broad-spectrum antimicrobial agents used in a range of consumer products, including personal care products, cosmetics, and food. Recently, the widespread use of parabens has raised concerns about the potential health risks associated with their endocrine-disrupting effect. In the present study, 2541 urine samples were collected and analyzed by liquid chromatography-mass spectrometry for the determination of the concentrations of methyl paraben (MeP), ethyl paraben (EtP), propyl paraben (PrP) and butyl paraben (BuP). The detection rate and geometric mean concentrations of parabens in the general population followed the order MeP (97.7%; 116ng/mL)>EtP (97.2%; 24.7ng/mL)>PrP (96.7%; 11.0ng/mL)>BuP (83.5%; 1.13ng/mL). The composition profiles showed that MeP and EtP accounted for >90% of the urinary paraben concentration. We performed statistical analysis in order to evaluate differences between demographic variables and urinary concentrations. Our results showed that adjusted proportional change of MeP, PrP, and BuP in adults were 2.67-6.13 times higher in females than in males. The urinary concentrations of PrP in adults increased significantly with age. The adjusted proportional changes of MeP and PrP in adults were associated with increased body mass index (BMI). The adjusted proportional changes of BuP and PrP in children and adolescents were 1.44 and 1.69 times higher in females than in males. However, there was no clear association between paraben concentrations and demographic variables in the children and adolescents groups. The estimated daily intake (EDIurine) of MeP and EtP in adults were 301μg/kg bw/day, which is lower than the acceptable daily intake (ADI; 10mg/kg bw/day). In summary, our results revealed that the general population in Korea was exposed to parabens during 2009-2010, and most Koreans are exposed to parabens. The urinary levels of parabens varied by age group with demographic factors in the Korean population. The results of study may be used to establish a nationally representative baseline of exposure to parabens in risk assessment., (Copyright © 2016. Published by Elsevier Inc.)

This study is a multi-center clinical study, which aimed to compare CA125, HE4, and risk of ovarian malignancy algorithm (ROMA) in predicting epithelial ovarian cancer of Korean women with a pelvic mass. Prospectively, serum from 90 Korean women with ovarian mass was obtained prior to surgery. For control group, serum from 79 normal populations without ovarian mass was also obtained. The HE4 and CA125 data were registered and evaluated separately and ROMA was calculated for each sample. Total 67 benign tumors and 23 ovarian cancers were evaluated. Median serum levels of HE4 and CA125, and ROMA score were significantly higher in patients with ovarian cancer than those with benign ovarian tumor and normal population (P < 0.001). In ROC curve analysis for women with a pelvic mass, area under the curve (AUC) for HE4 and ROMA was higher than CA125. Statistical differences in each study compared to CA125 were marginal (P compared to CA125; 0.082 for HE4 and 0.069 for ROMA). Sub-analysis revealed that AUC for HE4 and ROMA was higher than AUC for CA125 in post-menopausal women with a pelvic mass, but there were no statistically significant differences (P compared to CA125; 0.160 for HE4 and 0.127 for ROMA). Our data suggested that both HE4 and ROMA score showed better performance than CA125 for the detection of ovarian cancer in women with a pelvic mass. HE4 and ROMA can be a useful independent diagnostic marker for epithelial ovarian cancer in Korean women.

The aim of the present study was to investigate the prognostic role of a number of clinical factors in advanced cervical cancer patients. Patients (n=157) with stage IIA-IIB cervical cancer treated at four Hallym Medical Centers in South Korea (Hallym University Sacred Heart Hospital; Kangnam Sacred Heart Hospital; Chuncheon Sacred Heart Hospital; and Kangdong Sacred Heart Hospital) between 2006 and 2010 were retrospectively enrolled. Univariate analysis identified significant predictive values in the following eight factors: i) Cancer stage (P<0.0001); ii) tumor size (≤4 vs. 4-6 cm, P=0.0147; and ≤4 vs. >6 cm, P<0.0001); iii) serum squamous cell carcinoma antigen level (≤2 vs. >15 ng/ml; P=0.0291); iv) lower third vaginal involvement (P<0.0001); v) hydronephrosis (P=0.0003); vi) bladder/rectum involvement (P=0.0015); vii) pelvic (P=0.0017) or para-aortic (P=0.0019) lymph node (LN) metastasis detected by imaging vs. no metastasis; and viii) pelvic LN metastasis identified by pathological analysis (P=0.0289). Furthermore, multivariate analysis determined that tumor size (≤4 vs. 4-6 cm, P=0.0371; and ≤4 vs. >6 cm, P=0.0024) and pelvic LN metastasis determined by imaging vs. no metastasis (P=0.0499) were independent predictive variables. Therefore, tumor size and pelvic LN metastasis measured by imaging were independent predictive factors for the prognosis of advanced cervical cancer. These factors may provide more clinically significant prognostic information compared with the currently used International Federation of Gynecology and Obstetrics staging system.

Background: This study was designed to investigate the clinical characteristics correlated with serum CA19-9 elevation in primary mucinous ovarian tumors and to evaluate the role of serum CA19-9 in predicting borderline or malignant tumors. MATERIAL/METHODS We retrospectively identified 27 women with pathologically-confirmed primary ovarian mucinous neoplasms (16 borderline and 11 malignant), who had been preoperatively checked for serum CA19-9 and CA125 levels. The control group was established by 1:2 matching for age among all women with pathologically-confirmed benign mucinous tumors over the same time period. The associations of the serum CA19-9 elevation and clinical characteristics, including tumor pathology, were evaluated., Results: Serum CA19-9 was more frequently elevated in borderline or malignant than benign tumors (57.9% vs. 16.7%, P=0.001), although the mean value of serum CA19-9 was not significantly different among histological subtypes. CA19-9 elevation was correlated with large tumor size (largest diameter ≥15 cm; p=0.028), serum CA125 elevation (p=0.006), and tumor pathology (borderline or malignant tumors; p=0.001). Other clinical characteristics, including parity, menopause, bilateral tumor involvement, and torsion were not correlated with CA19-9 elevation. Multivariate analysis revealed that tumor pathology was the only independent factor for CA19-9 elevation in primary ovarian mucinous tumors (odds ratio 3.842, 95% CI 1.277-11.558, p=0.017). Interestingly, subgroup analysis in women with normal serum CA 125 level revealed that CA19-9 was significantly correlated with borderline and malignant tumors but not with benign tumors (odds ratio 6.3, 95% CI 1.438-19.648, p=0.014)., Conclusions: Serum CA19-9 can be a useful complementary marker in differentiating benign from borderline or malignant mucinous tumors in the ovaries, particularly when serum CA125 level is not elevated.

Hydroxyethylaminomethyl-4H-chromenones were previously discovered as fairly strong IL-5 inhibitor. For determination of detail structure activity relationship, N-substituted hydroxyethylaminomethylchromenones 4a-n were prepared and evaluated for their IL-5 inhibitory activity. Shifting the hydrophobic group to nitrogen from 1-position of hydroxyethylamino moiety of hydroxyethylaminomethyl-4H-chromenones enhances the activity. The increment in bulkiness or hydrophobicity of alkyl side chain at amino group increases the activity. The same level of activity of 5-(cyclohexylmethoxy)-3-(N-benzyl-2-hydroxyethylaminomethyl)-4H-chromenone analogs regardless of hydrophobic or hydrophilic substituents at 4th position of phenyl ring might infer the existence of tunnel structure in the putative receptor for accepting these side chains., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Introduction: There is no consensus on the extent of lymphadenectomy and the appropriate patients for lymphadenectomy in low-risk patients with endometrial cancer. This study aimed to evaluate the feasibility and effectiveness of laparoscopic lymphadenectomy for low-risk patients with endometrial cancer., Materials and Methods: From January 2004 to May 2008, we reviewed the medical records of 28 patients with low-risk, endometrial cancer; endometrioid type, grade 1 or 2, and with a depth of myometrial invasion of less than one-half of the myometrium. All patients underwent laparoscopically-assisted staging surgery., Results: The median age and body mass index were 56 years (range, 28 to 75) and 25.5 kg/m(2) (range, 21.3 to 37.2). The median operating time, estimated blood loss, and length of hospital stay were 142 minutes (range, 110 to 410), 215 mL (range, 100 to 700), and 7 days (range, 3 to 19), respectively. No conversion to laparotomy was noted. The median number of harvested lymph nodes was 21 (range, 10 to 48) pelvic nodes and 12 (range, 4 to 21) para-aortic nodes. One (3.6%) patient presented pelvic lymph node metastasis and 2 (7.1%) presented isolated para-aortic lymph node metastasis. The complication rate was 14.3%. No recurrence in the vaginal vault, distant metastasis, port site metastasis was noted up to the last follow-up., Conclusion: Systemic pelvic and para-aortic lymphadenectomy should be considered in all low-risk patients with endometrial cancer until it is concluded to be clinically insignificant through large-scale prospective research in the future. However, it will be difficult to explain statistical differences in survival rates according to lymphadenectomy, because the increase of the survival rate resulting from lymphadenectomy will fall within the margin of statistical error.

Aims: The aim of this study was to evaluate the feasibility and efficacy of laparoscopically-assisted staging surgery for ovarian cancer., Methods: Twenty four patients were evaluated. Among them, nineteen underwent initial laparoscopic staging surgery and five patients who were incompletely staged by other institutions underwent complete restaging surgery. The procedure included pelvic lymphadenectomy, paraaortic lymphadenectomy, multiple biopsies, washing cytology, infracolic omentectomy, and appendectomy. Laparoscopically assisted vaginal hysterectomy and bilateral salpingo-oophorectomy were performed on all patients except one. Parameters such as tumor diameter, operating time, estimated blood loss, length of hospital stay, number of harvested lymph nodes, intraoperative and postoperative complications, and recurrence were evaluated., Results: The patients' mean age was 52.8 +/- 11.3 years and the mean parity was 2.5 +/- 1.6. The mean diameter of the tumors was 8.4 +/- 3.3 cm, the mean operating time was 253.7 +/- 65.7 minutes, and the mean blood loss was 567.0 +/- 170.9 mL. The mean postoperative hospital stay was 10.6 +/- 4.0 days. The mean number of harvested pelvic lymph nodes was 22.5 +/- 8.9 and the mean number of harvested paraaortic lymph nodes was 11.0 +/- 5.8. None of the operations were switched to laparotomy. There were no major intraoperative complications, however, port site metastasis developed postoperatively in one patient., Conclusion: Comprehensive laparoscopically-assisted staging surgery, performed by a specialized laparoscopic oncologist with sufficient laparoscopic experience and a well-trained operating team, is both feasible and effective in treating ovarian cancers.

The purpose of this study was to evaluate the clinical value of serum tumor markers in patients with ovarian mature cystic teratoma (MCT). We retrospectively evaluated 163 women who underwent surgery for MCT of the ovary between March 2003 and August 2007 and who provided preoperative blood samples for the measurement of CA 19-9 and CA 125. The rates of elevated serum CA 19-9 and CA 125 levels were 31.9% (52/163) and 13.5% (22/163), respectively. The rate of ovarian torsion was 12.9% (21/163). There were significant differences between the elevated CA 19-9 group and the normal CA 19-9 group in the diameters of the tumors and the rates of ovarian torsion. Elevated serum CA 19-9 levels correlated with larger tumor diameters and higher torsion rates. CA 19-9 may be a useful tool for the diagnosis of ovarian MCT. Elevated CA 19-9 levels appear to correlate with larger tumor diameters and higher rates of ovarian torsion.

Study Objective: To evaluate the feasibility and efficacy of laparoscopic management of complications without conversion to laparotomy in gynecologic laparoscopic surgery., Design: Retrospective clinical study (Canadian Task Force classification III)., Setting: University teaching hospital., Patients: A total of 2668 women who underwent gynecologic laparoscopic surgeries from March 2003 through February 2008., Interventions: Gynecologic laparoscopic surgeries., Measurements and Main Results: We investigated major complications during gynecologic laparoscopic surgery. Based on patients' medical records, we reported types of laparoscopic surgery, types of complication, early recognition of complications, and treatment method of complications. Overall, 33 (1.24%) complications occurred in this study. There were 18 (0.67%) bladder injuries, 6 (0.22%) major vessel injuries, 3 (0.11%) bowel injuries, 3 (0.11%) ureteral injuries, 2 (0.07%) diaphragmatic injuries, and 1 (0.04%) intravesical foreign body. In all, 32 of 33 complications were successfully repaired laparoscopically. In 1 case, rectal perforation occurred on the third day after surgery; Hartmann operation followed by colostomy reversal was performed., Conclusion: Laparoscopic management of complications in gynecologic laparoscopic surgery is feasible and efficient.

Background: To evaluate the feasibility and efficacy of transrenal ureteral occlusion with microcoils in patients with ureterovaginal fistulas, Methods: Five women (median age 44 years, range 26-51 years) with ureterovaginal fistulas were treated by transrenal ureteral occlusion with microcoils. The underlying diseases were uterine fibroids (n = 3), a primitive neuroectodermal tumor of the uterine cervix (n = 1), and an ovarian cancer (n = 1). Microcoils with or without gelatin sponges, were placed antegradely through a percutaneous nephrostomy (PCN). A PCN tube was then placed to provide an external diversion, Results: The transrenal ureteral occlusion was technically successfully in all patients. Complete or near complete (<1 pad/day) dryness was obtained in all patients within 3 days. No complications other than a slight proximal migration of the microcoils in two patients occurred. The PCN tubes were removed in four of the five patients during the follow-up period with the subsequent procedures: antegrade ureteral stent placement, patent normal ureter, an ureteroneocystostomy and a laparoscopic end-to-end anastomosis of the ureter, Conclusions: Transrenal ureteral occlusion with microcoils with or without gelatin sponges is a safe and reliable method for the management of patients with ureterovaginal fistulas.

Background and Objective: In recent years, the incidence of endometrial cancer has gradually increased in Korea, and the use of laparoscopically assisted staging surgery (LASS) is increasing in this field. We conducted this study to evaluate the feasibility of LASS in Korean women with endometrial cancer., Methods: We conducted a retrospective review of 35 Korean women with endometrial cancer who were managed laparoscopically., Results: The median age and BMI were 57 years (range, 28 to 81) and 25.8 kg/m2 (range, 20.9 to 37.2), respectively. The median operating time, estimated blood loss, and length of hospital stay were, respectively, 150 minutes (range, 95 to 410), 250 mL (range, 50 to 1000), and 8 days (range, 3 to 20). No conversion to laparotomy was noted. The median number of harvested lymph nodes was 22 (range, 10 to 41) in pelvic lymph nodes and 7 (range, 2 to 21) in paraaortic lymph nodes. No vault recurrence or port-site metastasis was noted until the last follow-up., Conclusions: LASS can be performed without additional morbidity and complications, and might be feasible in Korean women with endometrial cancer.

The aim of this study was to assess the feasibility and efficacy of laparoscopic myomectomy (LM) for large myomas. A subpopulation of 51 patients with myomas 8 cm or larger in diameter was selected from 155 patients who underwent LM at Kangbuk Samsung Hospital from July 2003 to November 2006. The mean age of the patients was 34.9 +/- 5.6 yr, mean parity was 0.6 +/- 0.9, and 8 patients had a previous operative history. The most common operative indication was a palpable abdominal mass (24 patients, 47%). The mean operating time was 85.6 +/- 38.9 min, and the mean diameter of the largest myoma was 9.3 +/- 1.8 cm. The mean change in hemoglobin concentration was 2.1 +/- 1.2 g/dL. Histopathological diagnosis included 49 patients of leiomyoma (96.1%) and 2 patients of leiomyoma with adenomyosis (3.9%). Postoperatively, a transfusion was done in 7 patients, and a case of subcutaneous emphysema was noted. None of the operations was switched to laparotomy. With the newly-developed screw and the port placement system that was modified from the Choi's 4-trocar method to obtain better surgical vision, LM of large myomas proved to be one of the efficient and feasible methods.