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Decidualization of the endometrial stroma is an essential differentiation process for embryo implantation and maintenance of pregnancy. We previously reported that protein phosphatase 2A (PP2A) acts as a key mediator during cAMP-induced decidualization of human endometrial stromal cells (hESCs). However, the mechanism underlying its activation has remained obscure in hESCs. In the present study, we aimed to reveal the mechanism that induces the nitration of PP2A catalytic subunit (PP2Ac) during cAMP-induced decidualization of hESCs. First, cAMP-induced PP2Ac nitration was significantly repressed using L-NAME, an inhibitor of nitric oxide synthase (NOS). Among several NOS isoforms, only inducible NOS (iNOS) was highly expressed in hESCs, indicating that iNOS directly induces the nitration of PP2Ac. Second, cAMP-induced iNOS expression and PP2Ac nitration were decreased by treatment with TSA, an inhibitor of histone deacetylase 5 (HDAC5). cAMP-induced phosphorylation of CaMKII and HDAC5 was suppressed by treatment with U73122 (an inhibitor of phospholipase C) or transfection of PLCε siRNA. Finally, small G protein Rap1 and its guanine nucleotide exchange factor Epac1 were found to be involved in cAMP-induced PP2A activation. Taken together, our results suggest that PP2Ac nitration during cAMP-induced decidualization of hESCs is induced through the Epac1-Rap1-PLCε-CaMKII-HDAC5-iNOS signaling pathway.

Objective We evaluated the clinical characteristics of patients who underwent surgery after high intensity focused ultrasound (HIFU) to treat uterine leiomyoma. Methods From June 2016 to September 2017, patients at our hospital who underwent HIFU to treat uterine leiomyoma prior to surgery were enrolled. All patients underwent pelvic magnetic resonance imaging (MRI) before and after HIFU. If 6 months had passed since the last pelvic MRI was performed, imaging was performed again before the operation. Results A total of 12 patients were analyzed. The median age was 45 (range, 28-51) years. The median body mass index was 24.9 (range, 18.1-29.2) kg/m2. The median size of the leiomyoma was 10.1 (range, 7.8-14.0) cm before HIFU, which changed to 8.75 (range, 5.9-14.8) cm after HIFU. The median size increased to 9.1 (range, 5.9-18.0) cm before the operation. Surgery was planned for several reasons, including an increase in the leiomyoma size (n=6), persistent symptoms (n=4), and newly developed lesion (n=2). The median interval between HIFU and surgery was 7 (range, 3-32) months. Ten of the 12 patients underwent laparoscopic surgery, while the others underwent laparotomy; 6 patients also underwent laparoscopic myomectomy, and 4 underwent hysterectomy. Histopathologic findings showed infarction-type necrosis surrounded by granulation tissue with the infiltration of lymphocytes and macrophages in all patients. Conclusion Treatment of leiomyoma with operative procedures should be considered in selected patients with tumor size greater than 10 cm, multiple tumors, and persistent symptoms after HIFU treatment.

Uterine leiomyoma is a benign smooth muscle tumor of the uterus that can exhibit histopathological traits that mimic malignancy. Telomere shortening is an early event in tumorigenesis and telomerase activation facilitates tumor progression later in the course of carcinogenesis. Telomeric repeat‑binding factor (TRF)1 and TRF2 protect telomeres, and their gene expression levels are dysregulated in various cancer types. However, the roles of telomeres and telomere protection proteins in uterine leiomyoma remain largely unknown. In this study, telomere length and the mRNA levels of various telomere‑related genes in normal tissues and leiomyoma were determined, and their relationships were evaluated. Uterine leiomyoma and normal myometrium were surgically obtained from 18 and 13 patients, respectively. Telomere length and gene expression were determined by Southern blot analysis and reverse transcription‑quantitative PCR, respectively. In matched samples, telomeres were consistently shorter in leiomyoma tissue than in adjacent normal tissue. TRF1, TRF2, PIN2‑interacting telomerase inhibitor 1 (PINX1), and telomerase RNA component were expressed at comparable levels in both leiomyoma and normal tissues. None of these genes were associated with telomere length in leiomyoma. All tested tissues were negative for telomerase reverse transcriptase, which encodes the catalytic component of telomerase, indicating that cells in uterine leiomyoma were not immortalized. In summary, telomere erosion, which reflects active proliferation during tumor evolution, was evident in uterine leiomyoma. Steady‑state expression of TRF1, TRF2 and PINX1 may be important for maintenance of telomere integrity in leiomyoma, where telomere length is shortened.

Telomeres are transcribed into long non-coding RNA, referred to as telomeric repeat-containing RNA (TERRA), which plays important roles in maintaining telomere integrity and heterochromatin formation. TERRA has been well characterized in HeLa cells, a type of cervical cancer cell. However, TERRA abundance and stability have not been examined in other cervical cancer cells, at least to the best of our knowledge. Thus, in this study, we measured TERRA levels and stability, as well as telomere length in 6 cervical cancer cell lines, HeLa, SiHa, CaSki, HeLa S3, C-33A and SNU-17. We also examined the association between the TERRA level and its stability and telomere length. We found that the TERRA level was several fold greater in the SiHa, CaSki, HeLa S3, C-33A and SNU-17 cells, than in the HeLa cells. An RNA stability assay of actinomycin D-treated cells revealed that TERRA had a short half-life of ~4 h in HeLa cells, which was consistent with previous studies, but was more stable with a longer half-life (>8 h) in the other 5 cell lines. Telomere length varied from 4 to 9 kb in the cells and did not correlate significantly with the TERRA level. On the whole, our data indicate that TERRA abundance and stability vary between different types of cervical cancer cells. TERRA degrades rapidly in HeLa cells, but is maintained stably in other cervical cancer cells that accumulate higher levels of TERRA. TERRA abundance is associated with the stability of RNA in cervical cancer cells, but is unlikely associated with telomere length.

Decidualization of human endometrial stromal cells (hESCs) is crucial for successful uterine implantation and maintaining pregnancy. We previously reported that phospholipase D1 (PLD1) is required for cAMP-induced decidualization of hESCs. However, the mechanism by which phosphatidic acid (PA), the product of PLD1 action, might regulate decidualization is not known. We confirmed that PA induced decidualization of hESCs by observing morphological changes and measuring increased levels of decidualization markers such as IGFBP1 and prolactin transcripts (P < 0.05). Treatment with PA reduced phosphorylation of Akt and consequently that of FoxO1, which led to the increased IGFBP1 and prolactin mRNA levels (P < 0.05). Conversely, PLD1 knockdown rescued Akt phosphorylation. Binding of PP2A and Akt increased in response to cAMP or PA, suggesting that their binding is directly responsible for the inactivation of Akt during decidualization. Consistent with this observation, treatment with okadaic acid, a PP2A inhibitor, also inhibited cAMP-induced decidualization by blocking Akt dephosphorylation.

Nodular histiocytic and mesothelial hyperplasia (NHMH) is a rare and benign proliferative lesion composed of histiocytes with scattered mesothelial cells which was first reported in hernia sac by Rosai and Dehner in 1975 [1]. They described NHMH as a “benign reactive condition simulating a neoplastic process [1].” Since then, several cases have been reported in lung, pleura, inguinal region, urinary bladder, and pelvic cavity [2-9]. We report a case of incidentally detected NHMH, presenting as a pelvic nodule during laparoscopic surgery for uterine myoma and endometriosis.

Background: No large-scale clinical study has been done to show the standard surgical boundary and efficacy of laparoscopic para-aortic lymphadenectomy (LPAL). Objectives: Therfore, this study aimed to evaluate the feasibility, efficacy, and standard surgical boundary of LPAL performed up to the left renal vein level in gynecological malignancies. Methods: Medical records of 333 patients were retrospectively reviewed. All cases had gynecologic malignancies and had an operation including LPAL by a single surgical team between November 2003 and May 2018. Results: Three hundred twenty-six patients underwent LPAL as part of their staging, restaging, or debulking surgery. Seven patients with isolated para-aortic lymph node recurrence underwent a repeat LPAL. The median age and body mass index were 54 years (range, 28–81 years) and 26.0 kg/m2 (range, 20.3–37.2 kg/m2), respectively. The median operating time was 60 minutes (range, 24–135 minutes), and the median number of harvested para-aortic lymph nodes was 12 (range, 6–49). There were 11 cases of complications: 5 of major vessel injuries (3 inferior vena cava, 1 aorta, and 1 common iliac vein), 2 lymphocysts, 2 cases of chylous ascites, a cisterna chyli rupture, and 1 case of ureteric injury. There were 2 conversions to laparotomy: 1 left common iliac vein laceration that needed to be repaired and removal of an enlarged para-aortic lymph node completely. Conclusion: It is feasible and efficient to perform LPAL to the left renal vein level for women with gynecologic malignancies by well-trained gynecologic oncology surgeons according to our suggested standard surgical boundary.

OBJECTIVE To evaluate the safety and surgical outcomes of laparoscopically assisted vaginal hysterectomy (LAVH) for women with anterior wall adherence after cesarean section. METHODS We conducted a retrospective study of 328 women with prior cesarean section history who underwent LAVH from March 2003 to July 2013. The subjects were classified into two groups: group A, with anterior wall adherence (n=49); group B, without anterior wall adherence (n=279). We compared the demographic, clinical characteristics, and surgical outcomes of two groups. RESULTS The median age and parity of the patients were 46 years (range, 34 to 70 years) and 2 (1 to 6). Patients with anterior wall adherence had longer operating times (175 vs. 130 minutes, P

Objective To evaluate the feasibility, surgical outcomes and complications of laparoscopic restaging surgery for women with unexpected ovarian malignancy. Study design We conducted a retrospective chart review of 14 women with unexpected ovarian malignancy who underwent laparoscopic restaging surgery including peritoneal washing cytology, laparoscopic pelvic and paraaortic lymphadenectomy up to the left renal vein level, omentectomy, and multiple peritoneal biopsies, and hysterectomy except three fertility saving surgery. Results The median age and median body mass index women were 49 years (range, 22–63) and 24.2 m/kg 2 (range, 18.9–25.3), respectively. The median operating time was 230 min (range, 155–370). The median numbers of harvested pelvic and paraaortic lymph nodes were 26 (range, 6–41) and 18 (range, 2–40), respectively. The median return of bowel activity was 28 h (range, 21–79). Four of the women were upstaged from the initial presumed stage. There were two intraoperative complications, laceration of the inferior vena cava and cisterna chyli rupture. There was one postoperative complication, port-site metastasis. There was no conversion to laparotomic surgery. The median follow-up period was 33 months. Thirteen of the patients have no evidence of recurrences, however one patient died after 22 months after the surgery. Conclusion Laparoscopic restaging surgery, performed by a specialized laparoscopic oncologist with sufficient laparoscopic experience and a well-trained operating team, is both feasible and effective in the management of unexpected ovarian malignancies.

PinX1, a nucleolar protein of 328 amino acids, inhibits telomerase activity, which leads to the shortening of telomeres. The C-terminal region of PinX1 is responsible for its nucleolar localization and binding with TERT, a catalytic component of telomerase. A fraction of TERT localizes to the nucleolus, but the role of TERT in the nucleolus is largely unknown. Here, we report a functional connection between PinX1 and TERT regarding PinX1 stability. The C-terminal of PinX1(205-328), a nucleolar fragment, was much more stable than the N-terminal of PinX1(1-204), a nuclear fragment. Interestingly, PinX1 was less stable in TERT-depleted cells and more stable in TERT-myc expressing cells. Stability assays for PinX1 truncation forms showed that both PinX1(1-328) and PinX1(205-328), nucleolar forms, were more rapidly degraded in TERT-depleted cells, while they were more stably maintained in TERT-overexpressing cells, compared to each of the controls. However, PinX1(1-204) was degraded regardless of the TERT status. These results reveal that the stability of PinX1 is maintained in nucleolus in the presence of TERT and suggest a role of TERT in the regulation of PinX1 steady-state levels.

Aim To investigate the feasibility and safety of single port laparoscopic surgery (SP-LS) for ectopic pregnancy, irrespective of type of ectopic pregnancy and hemodynamic stability. Methods A prospective case–control study of 106 women who underwent SP-LS or conventional LS for a suspected ectopic pregnancy was performed at a university teaching hospital from January 2009 to March 2012. Twenty-six women underwent SP-LS (SP-LS group) and 80 women underwent conventional LS (conventional LS group). Results There were no statistical differences between the groups in terms of demographic characteristics, operating time, hemoglobin change, return of bowel activity, hospital stay or complication rate. There were no cases of additional trocar use or conversion to laparotomy. Of five women with heterotopic pregnancy, one underwent SP-LS, and three underwent conventional LS for tubal pregnancy, which all resulted in vaginal delivery without obstetric complication; one woman received SP-LS for cornual pregnancy and had an ongoing pregnancy. Conclusion SP-LS for ectopic pregnancy is feasible and safe regardless of the type of ectopic pregnancy and hemodynamic stability. However, further work is needed to confirm this conclusion and to demonstrate any advantage of SP-LS for ectopic pregnancy.

Aim To identify commonly occurring DNA copy number alterations in Korean cervical cancers. Methods DNA copy number alteration was screened by whole-genome array comparative genomic hybridization (CGH) analysis. For the array CGH discovery, genomic DNA from five cervical cancers and 10 normal cervical tissues were examined. For the independent validation of the most significant chromosomal alteration (1p36.22, PGD gene), 40 formalin-fixed paraffin-embedded cervical tissue samples were collected; 10 of them were used for quantitative polymerase chain reaction and the other 30 samples were used for immunohistochemical analysis. Chromosomal segments differently distributed between cancers and normal controls were determined to be recurrently altered regions (RAR). Results A total of 13 RAR (11 RAR losses and two RAR gains) were defined in this study. Of the 13 cervical cancer-specific RAR, RAR gain in the 1p36.22 locus where the PGD gene is located was the most commonly detected in cancers (P = 0.004). In the quantitative polymerase chain reaction replication, copy number gain of the PGD gene was consistently identified in cervical cancers but not in the normal tissues (P = 0.02). In immunohistochemical analysis, PGD expression was significantly higher in cervical cancers than normal tissues (P = 0.02). Conclusion Our results will be helpful to understand cervical carcinogenesis, and the PGD gene can be a useful biomarker of cervical cancer.

Aim The aim of this study was to investigate the obstetric outcomes and clinical efficacy of laparoscopic surgery for women with heterotopic pregnancy. Material and Methods We conducted a retrospective study of women who had undergone laparoscopic surgery for heterotopic pregnancy. The primary outcome was the feasibility of laparoscopic surgery for the treatment of heterotopic pregnancy and the secondary outcomes were obstetric outcomes. Results Seventeen women underwent laparoscopic surgery for heterotopic pregnancy: 14 with tubal heterotopic pregnancies and three with cornual heterotopic pregnancies. There were no intraoperative or postoperative complications. Of these women, 13 delivered 14 healthy babies, whereas two failed to maintain their pregnancies; one had a missed abortion 2 weeks after the surgery and the other had a miscarriage due to preterm premature rupture of the membrane at 16 gestational weeks. The remaining two women have ongoing pregnancies. Conclusion Laparoscopic surgery performed by experienced surgeons is a feasible and beneficial surgical modality for treating heterotopic pregnancy.

A 60-year-old Korean woman underwent laparoscopic bilateral salpingo-oophorectomy and was confirmed to have high-grade serous carcinoma of both ovaries with a huge omental cake, extensive agglutinated intra-abdominal metastatic masses, extensive serosa invasion of the intestines, and mesenterial deposits. She underwent 3 cycles of neoadjuvant chemotherapy followed by laparoscopic interval debulking surgery, including hysterectomy, pelvic and para-aortic lymphadenectomy, appendectomy, partial peritonectomy, and omentectomy. We encountered the right accessory polar renal artery (APRA) during the surgery and carefully preserved the right APRA from the abdominal aorta to the right kidney (Fig. 1). Postoperative computed tomography angiography showed an intact right APRA and normal-appearing kidney (Fig. 2). The patient had adjuvant chemotherapy and is alive without disease recurrence. Because APRA is a functional end artery, it is important to preserve it during surgery to prevent ischemic damage and renal failure [1]. It is very important for the gynecologic-oncologist to have knowledge of the retroperitoneal vascular anatomy, experience in laparoscopic surgery, and an accurate surgical technique to avoid vascular injury during laparoscopic para-aortic lymphadenectomy.

Objectives The primary objective was to compare cosmetic outcomes and patients’ satisfaction between women who underwent single port laparoscopic surgery (SP-LS) or conventional laparoscopic surgery (conventional-LS). The secondary objective was to evaluate the cosmetic effect of SP-LS in women with abdominal scars from prior surgeries. Study design Patients who were followed up after SP-LS or conventional-LS for gynecologic disease were included. Cosmetic outcome was evaluated at least six months after surgery. Objective and subjective scar analysis were performed using the Vancouver scar scale, the patient and observer scar assessment scale (POSAS), and a visual analog scale (VAS). Overall satisfaction with the surgery was evaluated with VAS. Results 130 women were included, with 65 women in each group. No difference in objective scar assessment for only umbilical scar was shown. In the subjective scar assessment and satisfaction with the surgery, SP-LS group was more satisfied. SP-LS group with abdominal scar had higher satisfaction in overall satisfaction with the scar. Conclusions SP-LS offers better cosmesis and overall patient satisfaction with surgery in women with gynecologic disease. SP-LS also seems to have considerable cosmetic benefit in women with abdominal scars from prior surgeries.

Study Objective To assess the feasibility and efficacy of laparoscopic lymphadenectomy in patients with isolated lymph node recurrences (ILNR) who underwent initial surgery because of gynecologic malignancy. Design Retrospective study (Canadian Task Force classification II-3). Setting University teaching hospital. Patients Six patients with ILNR (1 cervical, 4 ovarian, and 1 peritoneal) diagnosed between March 2003 and July 2010. Intervention Laparoscopic lymphadenectomy. Measurements and Main Results Median (range) patient age was 59.5 (24–70) years, and body mass index was 21.7 (21.0–24.6). There was no unplanned conversion to laparotomy. Operating time was 337.5 (200–400) minutes, hemoglobin change was 0.9 (0.4–2.6) g/dL, and hospital stay was 8.5 (5–19) days. The number of harvested lymph nodes was 20 (5–27), and of positive lymph nodes was 4 (1–24). One patient had common iliac vein laceration, with complete hemostasis achieved using intracorporeal suture. Postoperative lymphedema occurred in 1 patient, and was managed conservatively. All patients received adjuvant chemotherapy after laparoscopic lymphadenectomy. Conclusion Laparoscopic lymphadenectomy in patients with ILNR is feasible and might be an alternative therapeutic strategy.

Aim: This study was performed to assess the feasibility and efficacy of laparoscopic management for patients with large ovarian tumors. Material and Methods: A retrospective analysis was performed of the medical records of 52 women who underwent laparoscopic surgery for large ovarian tumors whose maximum diameter was ≥15 cm and a low possibility of malignancy. Results: The median age of patients was 35 years (range 18–84), median body mass index was 22.4 kg/m2 (range 12.4–31.5) and 18 patients had previous operative history. The median tumor diameter was 17 cm (range 15–40). There were no conversions to laparotomy and perioperative complications. The median operating time, estimated blood loss, and hospital stay were 80 min (range 25–225), 100 mL (range 50–500) and 3 days (range 2–14), respectively. The operative procedures performed were salpingo–oophorectomy (n = 26), ovarian cystectomy (n = 16), laparoscopically assisted vaginal hysterectomy with unilateral or bilateral salpingo-oophorectomy (n = 9), and laparoscopically assisted staging surgery (n = 1). The histopathological results were mucinous cystadenoma (n = 25), mature cystic teratoma (n = 9), serous cystadenoma (n = 6), endometrioma (n = 5), mucinous borderline tumor (n = 4), follicular cyst (n = 2), and clear cell carcinoma (n = 1). Conclusion: Laparoscopic management of large ovarian tumors is feasible and efficient with appropriate patient selection and experience of surgeons.

Objective. To investigate the effects of conventional and single port laparoscopically assisted vaginal hysterectomy (LAVH) on sexual function in premenopausal women. Design. A prospective case-control study. Setting. University teaching hospital. Population. A total of 95 premenopausal women having LAVH from January 2009 to December 2009. Methods. Comparison of 47 premenopausal women who had single port LAVH using trans-umbilical GelPort access (SP-LAVH group) and 48 premenopausal women who had conventional multiport LAVH (conventional LAVH group). Main outcome measures. Evaluation of sexual function was done prior to and six months after surgery using a validated tool, the female sexual function index (FSFI). Results. In terms of women’s demographic characteristics and operative results, there was no signif icant difference between the two study groups, or between pre- and postoperative individual domain scores or total female sexual function index in women who underwent either conventional or single port LAVH. Conclusions. Neither conventional nor single port LAVH affects sexual function in premenopausal women. Women can be counseled that this type of surgery is unlikely to alter sexual function.

The purpose of this study was to evaluate the feasibility and efficacy of laparoscopic lymphadenectomy in patients with gynecologic malignancies and improve upon the existing published data regarding laparoscopic lymphadenectomy.We conducted a retrospective chart review of 225 patients with various gynecologic malignancies who had undergone laparoscopic pelvic lymphadenectomy (LPL) and/or laparoscopic para-aortic lymphadenectomy (LPAL) at Kangbuk Samsung Hospital between November 2003 and October 2010.One hundred and seventy-two patients underwent both LPL and LPAL, 47 patients underwent LPL alone, and six patients underwent a repeat laparoscopic lymphadenectomy. The median age and body mass index of the patients were 49.4 years (range 23-79 years) and 24.2 kg/m(2) (range 17.5-37.2 kg/m(2)). The median numbers of harvested pelvic and para-aortic lymph nodes were 25.9 (range 3-63) and 10.6 (range 1-34), respectively. The median operating times for the LPL and LPAL were 72.3 min (range 40-120 min) and 40 min (range 20-70 min), respectively. There were seven cases of major vessel injuries, two lymphocytes, two lymphedemas, and two chylous ascites. There was no unplanned conversion to laparotomy.Laparoscopic lymphadenectomy can be considered a technically feasible and safe procedure and has become the alternative modality in the field of gynecologic oncology surgery. And our results could reinforce the existing published data regarding laparoscopic lymphadenectomy.

The goal of this study was to evaluate the operative feasibility and survival for patients with stage IB2 cervical cancer who undergo laparoscopic radical vaginal hysterectomy (LRVH) compared with those with stage IB1 cervical cancer. We identified 90 patients who were eligible to participate in the study through retrospective analysis of medical records from March 2003 to June 2010. Patients with stage IB1 cervical cancer were divided into two groups by a cutoff value of 2 cm for tumor size. Data regarding surgicopathologic risk factors, surgical outcomes, and survival rates were compared among three groups (two with stage IB1 and one with stage IB2). The tumor size was ≤2 cm in 27 patients, 2–4 cm in 30, and >4 cm in 33. The number of intermediate and high-risk factors was significantly lower in patients with stage IB1 cervical cancer (≤2 cm) than in those with stage IB2. Surgical outcomes (mean operating time, estimated blood loss, number of harvested lymph nodes, and sites of metastatic lymph nodes) did not show any significant difference among the three groups. The rates of intraoperative complications also did not differ among the three groups (P = 0.833). The estimated 5-year recurrence-free and overall survival rates were not significantly different among the three groups (P = 0.253 and 0.525, respectively). LRVH for stage IB2 cervical cancer can be performed with similar safety and survival rates compared to stage IB1 cervical cancer. Overall, LRVH is feasible for the treatment of stage IB2 cervical cancer.

Aim: To evaluate the feasibility, efficacy, and safety of laparoscopic surgery for benign gynecological disease in women over 70 years old. Materials and Methods: Fifty-four women over 70 years old underwent surgery for benign gynecological disease from January 2003 to December 2009. Each woman was matched with two subjects of 30–50 years old in the younger group; the matching with patients undergoing a similar surgical technique was retrospective from December 2009. We evaluated body mass index, comorbidities, number of previous abdominal surgeries, operating time, hemoglobin change, postoperative complications, hospital stay, and return of bowel activity. The χ2-test and t-test were used to compare the results of the elderly group and the younger group. Results: There were no significant differences between the elderly group (over 70 years old) and a matched younger group (aged 30–50 years old) in body mass index, number of previous abdominal surgeries, operating time, hospital stay, and postoperative complications. Conclusion: Laparoscopic surgery in elderly women for benign gynecological disease is feasible, efficient, and safe. However, a large prospective randomized study is needed to confirm the conclusion.

The aim of our study was to assess the feasibility and efficacy of laparoscopically assisted vaginal hysterectomy (LAVH) with the two-port method. One hundred seventy-six women with uterine diseases underwent LAVH using the two-port method. We reviewed the medical records of the patients’ age, parity, body mass index, history of previous abdominal surgery, operative indications, histopathological diagnosis, operating time, weight of the removed uterus, change in the hemoglobin levels, hospital stay, and occurrence of any complications. The median age of the patients was 46 years (range, 33–60 years), the median parity was 2 (range, 0–5), and the median body mass index was 23.4 kg/m2 (range, 17.6–29.6 kg/m2). Forty-two patients (23.9%) had previous abdominal operative history. The most common operative indication was menorrhagia, and the most common histopathological diagnosis was leiomyoma. The median operating time was 58 min (range, 30–150 min), and the median weight of the removed uterus was 230 g (range, 60–660 g). The median change in the hemoglobin level was 1.7 g/dL (range, 0.1–3.8 g/dL). The median hospital stay was 3 days (range, 2–7 days). An ileus occurred postoperatively in one patient, which was managed conservatively. No additional port was required in any of the cases. No operation was converted to an abdominal hysterectomy. LAVH using the two-port technique with the aid of a 5-mm telescope and an endoscopic stapler is both feasible and efficient.

Background: Appendicitis is one of the most frequent acute surgical conditions of the abdomen, and appendectomy is one of the most commonly performed operations in the world. However, epidemiological data on appendicitis have not been reported for South Korean or East Asian populations.Methods: We analyzed the epidemiological features and lifetime risk of appendicitis and appendectomy in South Korea using data collected for the national health insurance database from 2005 through 2007.Results: Appendectomy was performed in 59.70% of inpatients diagnosed with appendicitis. The overall incidences of appendicitis, total appendectomy, and perforated appendectomy were 22.71, 13.56, and 2.91 per 10 000 population per year, respectively. The incidence of appendicitis and appendectomy showed clear seasonality, with a peak in summer. The standardized lifetime risks of appendicitis and appendectomy were constant from 2005 through 2007. A life table model suggests that the lifetime risk of appendicitis is 16.33% for males and 16.34% for females, and that the lifetime risk of appendectomy is 9.89% for males and 9.61% for females.Conclusions: As compared to results obtained in research on Western populations, appendicitis and appendectomy had a similar perforation rate and seasonality, but a higher overall incidence, in South Koreans. Between 2005 and 2007, the incidence of appendicitis and appendectomy was constant. Overall, an estimated 15 incidental appendectomies are performed to prevent 1 inpatient with suspected appendicitis, and 26 incidental appendectomies are performed to prevent 1 appendectomy. Incidental appendectomy may have greater preventive value in Koreans.

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/m2 (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. Key words: Endometrial cancer, Laparoscopy, Lymphadenectomy

To mitigate TOT complications we designed a modified TOT technique called canal TOT. We describe this new technique and evaluate its feasibility.Between October 2006 and June 2007, 105 consecutive women with stress urinary incontinence underwent a canal TOT procedure. Two oblique lateral incisions were made in the anterior vaginal wall and a suburethral canal was created between the incisions. Mesh was transferred beneath the canal. The subsequent canal TOT surgical steps were identical to those of the original TOT procedure. All patients were evaluated by urological examination and self-assessment questionnaires (Incontinence Impact Questionnaire-Short Form and Urogenital Distress Inventory-Short Form) preoperatively and 12 months postoperatively. Reportedly dyspareunia developed after the operation.A minimum 1-year followup was available in 99 patients. Median operative time was 25 minutes (range 15 to 50). No mesh erosion, retropubic hematoma or complete bladder retention developed. Transient postoperative voiding dysfunction and transient de novo urgency were observed in 2 (2.0%) and 8 patients (8.1%), respectively. Dyspareunia developed after surgery in 4 patients (4.0%). Postoperatively Incontinence Impact Questionnaire-Short Form and Urogenital Distress Inventory-Short Form scores decreased significantly (p0.05). Objective and subjective cure rates were 98.0% and 89.9%, respectively.The canal TOT procedure is feasible and effective for mitigating the complications of the original TOT procedure. This technique might be especially useful in patients with cystocele because of the paravaginal defect as well as in patients with obesity or prior vaginal surgery. However, a large-scale and long-term followup study is required to verify the effectiveness of this technique.

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.

Introduction: The purpose of the present study was to assess the objective and subjective efficacy of the distal urethral polypropylene sling (DUPS) for urodynamic stress incontinence (USI) in Korean women. Patients and Methods: We performed DUPS in 89 consecutive patients with USI. The Incontinence Impact Questionnaire (IIQ-7) and the Urogenital Distress Inventory (UDI-6) were used to evaluate the surgical outcomes. Results: The mean operative time was 29.4 min (range 25–40). Concomitant procedures were performed including rectocele repair (n = 48), laparoscopically assisted vaginal hysterectomy (n = 12) and laparoscopic myomectomy (n = 1). There were no intraoperative complications or major postoperative complications. The average follow-up was 15 months (range 12–18). Both mean IIQ-7 and UDI-6 scores decreased significantly after DUPS. In addition, 87% of the patients reported no symptoms of USI under any circumstances and 95% of the patients reported never or rarely being bothered by USI. Conclusions: DUPS is a safe, inexpensive, simple, and effective surgical method for USI. The procedure provides a high cure rate in Korean women.

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.