자궁 적출술 방법 결정을 위한 복식과 질식 전 자궁 적출술의 비교 연구

최현수(Hyun Soo Choi),이선경(Seun Kyung Lee),김승보(Seung Bo Kim) 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.6

Objectives : The most often perfomed major operation in gynecology is hysterectomy.Our purpose was to compare the indications, charateristics and outcomes of patients undergoing total abdominal hysterectomy and total vaginal hysterectomy and to help to establish guidelines to determine the route of hysterectomy.Method : The hospital charts of 400 women who underwent elective inpatient hysterectomy at Kyung-Hee University hospital from January 1994 to January 1999, were abstracted retrospectively. Data were collected regarding patients, age, parity, preoperative indications, the route of hysterectomy, uterine weight, operative and postoperative complications and the length of stay. The operative indications were benign uterine disease except from uterine prolapse. Bisection or combined morcellation were used in most cases to obtain reduction in uterine size.Result : Patients in whom the vaginal route was successful included 18% of those with uterine weights exceeding 280gm. There was statistically significant difference for uterine weight, operative time, bleeding amount, the length of stay in two camparative group. 4% of vaginal hysterectomy and 7% of total abdominal hysterectomy has documented operative complications.Conclusion : Vaginal hysterectomy is safe operation with few intraoperative and postoperative complications without notable blood loss. Vaginal hysterectomy allow one to shorten the operating time and allows early postoperative discharge of some patients from hospital. Skilled performance of vaginal hysterectomy is worth greater attention and should be used more often in gynecological study.

복강경하 질식 자궁적출술의 임상체험 43 예

강용필(YP Kang),이상녕(SN Lee),강창구(CG Kang),이주엽(JY Lee),김동진(DJ Kim),기광수(KS Kee),임헌정(HJ lm) 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.10

Hysterectomy is the most common gynecologic operation. Traditionally, hysterectomy was performed either through an abdominal approach or through a vaginal approach. The merits, indications, and contraindications for each approach have been debate for many years. Complication rate of vaginal hysterectomy is lower than abdomnal hysterectomy but, only 30% of hysterectomy was performed through a vaginal approach. With the addition of laparoscope in hysterectomy, it offers a technique to convert some abdominal hysterectomies into vaginal hysterectomies. This clinical study is a retrospective review of 43 cases of laparoscopically assisted vaginal hysterectomy (LAVH) between May 1997 and Feb 1998. We used simple electrosurgical technique and avoid the use of disposable staples and other instruments. The surgical indications of hysterectomy were myoma uteri (51.2%), dysmenorrhea and pelvic pain (20.9%), dysfunctional uterine bleeding (18.6%), cervical intraepithelial neoplasia (7.0%), and others (2.3%). Average operative time was 123.14±37.99 minutes. The mean uterine weight was 276.40±119.83 gram. The mean blood loss was 304.07±212.41 ml. The most common associated procedure with LAVH was unilateral salpingoophorectomy, which comprise 11.6%, posterior colporrhaphy (9.3%), adhesiolysis (7.0%), bilateral salpingoophorectomy (2.3%), salpingectomy (2.3%) were also carried out concomitantly. The comlication rate was 11.6% and the most common one is blood transfusion (6.9%). But, compared with other route of hysterectomy, overall complication rate was markedly decreased. This report suggest that LAVH can decrease the number of patients requiring a laparotomy for hysterectomy. It appears useful when adnexal indication for surgery or adhesion is exists. And it provides a shorter hospital stay, quicker recovery, fewer complications than those undergoing the same procedeure abdominally. But, operative time and blood loss were increased than abdominal hysterectomy.

복강경하 전자궁적출술과 질식 전자궁적출술의 임상적 비교

전춘식 ( Chun Sik Jeon ),원재연 ( Jae Yeon Won ),김진홍 ( Jin Hong Kim ),이춘희 ( Chun Hee Lee ),방준배 ( Jun Bae Bang ),이윤순 ( Yoon Soon Lee ),박일수 ( Il Sooo Park ) 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.12

By rapid development of laparoscopec technique and equipment, laparoscopic hysterectromy(LH), even to total laparoscopic hysterectomy and laparoscopic radical hysterectomy has been possible. The objective of this study was to review the indications, outcomes, complications of laparoscopic hysterectomy in comparison with total vaginal hysterectomy(TVH) and to evaluate the value of laparoscopic hysterectomy. Initial 50 cases of laparoscopic hysterectomy were performed from September 1994 to July 1995 and 50 cases of vaginal hysterectomy were randomly chosen from March 1993 to July 1994. The mean age of LH and TVH was 45.0±6.5 and 44.6±7.15(p=0.758). The mean parity of LH and TVH was 1.78±0.76 and 3.00±1.34(p=0.0001). The most common surgical indication for LH and TVH was myoma including adenomyosis (88 % and 54 %). The most common combined procedure with LH and TVH was adnexectomy(98% and 28%). The mean operation time for LH was significantly longer than TVH(125 min vs 68 min). There were no significant differences in hospital stay(4.6 days vs 4.1 days) and estimated blood loss(134 ml vs 182 ml) between LH and TVH. The mean uterine weight of LH was significantly heavier than TVH(323 gm vs 197.6 gm). The complication rate of LH and TVH was 26 % and 12 %. Our study strongly suggest that main prerequisute for laparoscopic hysteretomy are 1) nullipara with narrow vagina and elderly women with vaginal atropy 2) the need to guarantee removal of the ovaries 3) suspected adnexal pathology, e.g. PID, endometriosis. Moderately to severely enalrged uterus certainly is not itself indication for laparosopic hysterectomy but rather make an easy to perform vaginal hysterectomy. Laparosopic pelvic surgeons make an effort to reduce operation time and complication rate by repetition of education, video sessions, and animal model training. Most consider laparosopic hysterectomy to be a substitute for total abdominal hysterectomy, not for vaginal hysterectomy. It is clear that not all patients requiring hysterectomy will benefit from the laparoscopic approach. Proper selection for laparoscopic hysterectomy will decrease the need of laparotomy and the risk of physical and mental trauma according to laparotomy will be reduced and quality of women`s life will be raised.

Clinical outcomes of hysterectomy for benign diseases in the female genital tract: 6 years’ experience in a single institute

Hyo-Shin Kim,구유진,이대형 영남대학교 의과대학 2020 Yeungnam University Journal of Medicine Vol.37 No.4

Background: Hysterectomy is one of the major gynecologic surgeries. Historically, several surgical procedures have been used for hysterectomy. The present study aims to evaluate the surgical trends and clinical outcomes of hysterectomy performed for benign diseases at the Yeungnam University Hospital. Methods: We retrospectively reviewed patients who underwent a hysterectomy for benign diseases from 2013 to 2018. Data included the patients’ demographic characteristics, surgical indications, hysterectomy procedures, postoperative pathologies, and perioperative outcomes. Results: A total of 809 patients were included. The three major indications for hysterectomy were uterine leiomyoma, pelvic organ prolapse, and adenomyosis. The most common procedure was total laparoscopic hysterectomy (TLH, 45.2%), followed by open hysterectomy (32.6%). During the study period, the rate of open hysterectomy was nearly constant (29.4%–38.1%). The mean operative time was the shortest in the single-port laparoscopic assisted vaginal hysterectomy (LAVH, 89.5 minutes), followed by vaginal hysterectomy (VH, 96.8 minutes) and TLH (105 minutes). The mean decrease in postoperative hemoglobin level was minimum in single-port LAVH (1.8 g/dL) and VH (1.8 g/dL). Conversion to open surgery or multi-port surgery occurred in five cases (0.6%). Surgical complications including wound dehiscence, organ injuries, and conditions requiring reoperation were observed in 52 cases (6.4%). Conclusion: Minimally invasive approach was used for most hysterectomies for benign diseases, but the rate of open hysterectomy has mostly remained constant. Single-port LAVH and VH showed the most tolerable outcomes in terms of operative time and postoperative drop in hemoglobin level in selected cases.

Laparoscopic total hysterectomy versus laparoscopic supracervical hysterectomy: The effect on female sexuality

( An Na Nam ),( Si Hyun Cho ),( Seok Kyo Seo ),( Young Eun Jeon ),( Hye Yoen Kim ),( Young Sik Choi ),( Byung Seok Lee ) 대한산부인과학회 2008 Journal of Womens Medicine Vol.1 No.1

Objective: This study was designed to compare the effects of laparoscopic total hysterectomy and laparoscopic supracervical hysterectomy on female sexual quality. Methods: A Prospective observational study over 6 months was performed. Ninety four patients who had laparoscopic hysterectomy for benign disease excluding uterine prolapse and endometriosis were recruited to the study. All patients completed a questionnaires for self report of changes in sexual quality before laparoscopic total or supracervical hysterectomy and six months after surgery. Results: Compared to the laparoscopic total hysterectomy group, those who had laparoscopic supracervical hysterectomy had a shorter time to the first intercourse after surgery (5.78 weeks vs. 4.92 weeks, p=0.001). The overall sexual quality after surgery remained unchanged; it was 90.2% for the total group and 87.2% for the supracervical laparoscopic hysterectomy cases. Conclusions: The quality of sexual life did not show significant change in most cases after either laparoscopic total hysterectomy or laparoscopic supracervical hysterectomy.

Total laparoscopic hysterectomy versus da Vinci robotic hysterectomy: is using the robot beneficial?

Enrique Soto,Yungtai Lo,Kathryn Friedman,Carlos Soto,Farr Nezhat,Linus Chuang,Herbert Gretz 대한부인종양학회 2011 Journal of Gynecologic Oncology Vol.22 No.4

Objective: To compare the outcomes of total laparoscopic to robotic approach for hysterectomy and all indicated procedures after controlling for surgeon and other confounding factors. Methods: Retrospective chart review of all consecutive cases of total laparoscopic and da Vinci robotic hysterectomies between August 2007 and July 2009 by two gynecologic oncology surgeons. Our primary outcome measure was operative procedure time. Secondary measures included complications, conversion to laparotomy, estimated blood loss and length of hospital stay. A mixed model with a random intercept was applied to control for surgeon and other confounders. Wilcoxon rank-sum, chi-square and Fisher’s exact tests were used for the statistical analysis. Results: The 124 patients included in the study consisted of 77 total laparoscopic hysterectomies and 47 robotic hysterectomies. Both groups had similar baseline characteristics, indications for surgery and additional procedures performed. The difference between the mean operative procedure time for the total laparoscopic hysterectomy group (111.4 minutes) and the robotic hysterectomy group (150.8 minutes) was statistically significant (p=0.0001) despite the fact that the specimens obtained in the total laparoscopic hysterectomy group were significantly larger (125 g vs. 94 g, p=0.002). The robotic hysterectomy group had statistically less estimated blood loss than the total laparoscopic hysterectomy group (131.5 mL vs. 207.7 mL, p=0.0105) however no patients required a blood transfusion in either group. Both groups had a comparable rate of conversion to laparotomy, intraoperative complications, and length of hospital stay. Conclusion: Total laparoscopic hysterectomy can be performed safely and in less operative time compared to robotic hysterectomy when performed by trained surgeons. Objective: To compare the outcomes of total laparoscopic to robotic approach for hysterectomy and all indicated procedures after controlling for surgeon and other confounding factors. Methods: Retrospective chart review of all consecutive cases of total laparoscopic and da Vinci robotic hysterectomies between August 2007 and July 2009 by two gynecologic oncology surgeons. Our primary outcome measure was operative procedure time. Secondary measures included complications, conversion to laparotomy, estimated blood loss and length of hospital stay. A mixed model with a random intercept was applied to control for surgeon and other confounders. Wilcoxon rank-sum, chi-square and Fisher’s exact tests were used for the statistical analysis. Results: The 124 patients included in the study consisted of 77 total laparoscopic hysterectomies and 47 robotic hysterectomies. Both groups had similar baseline characteristics, indications for surgery and additional procedures performed. The difference between the mean operative procedure time for the total laparoscopic hysterectomy group (111.4 minutes) and the robotic hysterectomy group (150.8 minutes) was statistically significant (p=0.0001) despite the fact that the specimens obtained in the total laparoscopic hysterectomy group were significantly larger (125 g vs. 94 g, p=0.002). The robotic hysterectomy group had statistically less estimated blood loss than the total laparoscopic hysterectomy group (131.5 mL vs. 207.7 mL, p=0.0105) however no patients required a blood transfusion in either group. Both groups had a comparable rate of conversion to laparotomy, intraoperative complications, and length of hospital stay. Conclusion: Total laparoscopic hysterectomy can be performed safely and in less operative time compared to robotic hysterectomy when performed by trained surgeons.

Robotic single-port transumbilical total hysterectomy: a pilot study

남은지,김상운,이마리아,임가원,백지흠,이산희,김성훈,김재훈,김재욱,김영태 대한부인종양학회 2011 Journal of Gynecologic Oncology Vol.22 No.2

Objective: To evaluate the feasibility of robotic single-port transumbilical total hysterectomy using a home-made surgical glove port system. Methods: We retrospectively reviewed the medical records of patients who underwent robotic single-port transumbilical total hysterectomy between January 2010 and July 2010. All surgical procedures were performed through a single 3-4-cm umbilical incision, with a multi-channel system consisting of a wound retractor, a surgical glove, and two 10/12-mm and two 8 mm trocars. Results: Seven patients were treated with robotic single-port transumbilical total hysterectomy. Procedures included total hysterectomy due to benign gynecological disease (n=5), extra-fascial hysterectomy due to carcinoma in situ of the cervix (n=1), and radical hysterectomy due to cervical cancer IB1 (n=1). The median total operative time was 109 minutes (range, 105 to 311 minutes), the median blood loss was 100 mL (range, 10 to 750 mL), and the median weight of the resected uteri was 200 g (range, 40 to 310 g). One benign case was converted to 3-port robotic surgery due to severe pelvic adhesions, and no post-operative complications occurred. Conclusion: Robotic single-port transumbilical total hysterectomy is technically feasible in selected patients with gynecological disease. Robotics may enhance surgical skills during single-port transumbilical hysterectomy, especially in patients with gynecologic cancers. Objective: To evaluate the feasibility of robotic single-port transumbilical total hysterectomy using a home-made surgical glove port system. Methods: We retrospectively reviewed the medical records of patients who underwent robotic single-port transumbilical total hysterectomy between January 2010 and July 2010. All surgical procedures were performed through a single 3-4-cm umbilical incision, with a multi-channel system consisting of a wound retractor, a surgical glove, and two 10/12-mm and two 8 mm trocars. Results: Seven patients were treated with robotic single-port transumbilical total hysterectomy. Procedures included total hysterectomy due to benign gynecological disease (n=5), extra-fascial hysterectomy due to carcinoma in situ of the cervix (n=1), and radical hysterectomy due to cervical cancer IB1 (n=1). The median total operative time was 109 minutes (range, 105 to 311 minutes), the median blood loss was 100 mL (range, 10 to 750 mL), and the median weight of the resected uteri was 200 g (range, 40 to 310 g). One benign case was converted to 3-port robotic surgery due to severe pelvic adhesions, and no post-operative complications occurred. Conclusion: Robotic single-port transumbilical total hysterectomy is technically feasible in selected patients with gynecological disease. Robotics may enhance surgical skills during single-port transumbilical hysterectomy, especially in patients with gynecologic cancers.

Comparative Effectiveness of Abdominal versus Laparoscopic Radical Hysterectomy for Cervical Cancer in the Postdissemination Era

김진희,김경주,박서진,이정윤,김기동,임명철,김재원 대한암학회 2019 Cancer Research and Treatment Vol.51 No.2

Purpose Despite the benefits of minimally invasive surgery for cervical cancer, there are a lack of randomized trials comparing laparoscopic radical hysterectomy and abdominal radical hysterectomy. We compared morbidity, cost of care, and survival between abdominal radical hysterectomy and laparoscopic radical hysterectomy for cervical cancer. Materials and Methods We used the Korean nationwide database to identify women with cervical cancer who underwent radical hysterectomy from January 1, 2011 to December 31, 2014. Patients who underwent abdominal radical hysterectomy were compared to those who underwent laparoscopic radical hysterectomy. Perioperative morbidity, the use of adjuvant therapy, and survival were evaluated after propensity score balancing. Results We identified 6,335 patients, including 3,235 who underwent abdominal radical hysterectomy and 3,100 who underwent laparoscopic radical hysterectomy. The use of laparoscopic radical hysterectomy increased from 46.1% in 2011 to 51.8% in 2014. Patients who were younger, had a more recent year of diagnosis, and were treated in the metropolitan area were more likely to undergo a laparoscopic procedure (p < 0.001). Compared to abdominal radical hysterectomy, laparoscopic radical hysterectomy was associated with lower rates of complication, fewer transfusions, a shorter hospital stay, less adjuvant therapy, and reduced total medical costs (p < 0.001). Laparoscopic surgery was associated with a better overall survival than abdominal operation (hazard ratio, 0.74; 95% confidence interval, 0.64 to 0.85). Conclusion In the postdissemination era, laparoscopic radical hysterectomy was associated with more favorable morbidity profiles, a lower cost of care, and comparable survival than abdominal radical hysterectomy.

500 g 이상의 거대자궁에 대한 단일공 복강경하 자궁절제술

이건우 ( Geon Woo Lee ),김장규 ( Jang Keu Kim ),신창수 ( Chang Su Shin ),최원규 ( Won Kyu Choi ),강병헌 ( Byung Hun Kang ),양정보 ( Jung Bo Yang ),고영복 ( Young Bok Koh ),이기환 ( Ki Hwan Lee ) 대한산부인과학회 2012 Obstetrics & Gynecology Science Vol.55 No.6

Objective To compare the outcomes of single port access (SPA) laparoscopic hysterectomy and conventional laparoscopic hysterectomy for the large uterus of more than 500 g. Methods Twenty-seven cases of SPA laparoscopic hysterectomy and 32 cases of conventional laparoscopic hysterectomy were retrospectively analysed. The surgery had performed by single surgeon from January 2010 to July 2011 in Chungnam National University Hospital. We compared demographic characteristics and surgical outcomes. Results There were no significant difference in patients` age, body mass index, past surgical history, postoperative additional pain control and duration of hospital stay between the two groups. Uterine weight was 706.5±363.2 g (range, 500-2,415 g) for SPA laparoscopic hysterectomy and 634.0±153.3 g (range, 500-1,130 g) for conventional laparoscopic hysterectomy and signifi cantly not different between the two groups. Operation time was signifi cantly longer in SPA laparoscopic hysterectomy than conventional laparoscopic hysterectomy (81.1±18.1 minutes vs. 67.2±16.8 minutes). Postoperative change in hemoglobin and hematocrit was statistically higher in SPA laparoscopic hysterectomy than conventional laparoscopic hysterectomy (1.9±0.9g/dL, 2.9±4.2% vs. 1.0±1.3g/dL, 6.2±2.9%, respectively). Conclusion Operation time was longer and postoperative change in hemoglobin and hematocrit was signifi cantly higher in SPA laparoscopic hysterectomy than conventional laparoscopic hysterectomy. However, SPA laparoscopic hysterectomy will replace conventional laparoscopic hysterectomy in a future with improving surgical technique.

양성 자궁병변에 대한 세 가지 다른 자궁적출술 접근 방법

한호섭 ( Ho Suap Hahn ),최규홍 ( Kyu Hong Choi ),김주명 ( Joo Myung Kim ),이현주 ( Hyun Joo Lee ),최노미 ( No Mi Choi ),유원식 ( Won Sik Yoo ),김경연 ( Kyung Yeon Kim ),김남숙 ( Nam Sook Kim ),조수희 ( Soo Hee Jo ),홍준식 ( Jun Sh 대한산부인과학회 2007 Obstetrics & Gynecology Science Vol.50 No.5

Objective: To evaluate the rates and clinical outcomes between abdominal hysterectomy (AH), laparoscopic hysterectomy (LH) and vaginal hysterectomy (VH). Methods: Medical records of 236 patients who underwent hysterectomy (by one surgeon) for benign uterine pathology between march 2004 and april 2006 were reviewed. Primary outcome measure was the rate of each method of hysterectomy. Secondary outcome measures included perioperative and postoperative outcomes between groups. Results: The mean age, weight, height, body mass index, and parity in three groups showed no difference. In two hundred and twenty two cases of hysterectomies, the rate of AH was 13.5%, LH 34.2%, and VH 52.3%. Perioperative outcomes of AH, LH and VH were as follows : operative time (83.2±27.1 min, 94.2±25.2 min, and 50.8±15.5 min, respectively), change in hemoglobin (2.3±1.5 g/dL, 2.0±0.9 g/dL, and 1.3±1.1 g/dL, respectively), duration of urinary catheterization (2.0±0.2 days, 1.0±0.0 days, and 1.0±0.4 days, respectively), postoperative hospitalization (5.7±1.2 days, 4.7±0.9 days, and 4.3±1.0 days, respectively), uterine weight (733±665 g, 340±213 g, and 300±156 g, respectively). Uterine weight in the AH group was significantly heavier than in the LH and VH. The benefits of LH versus AH were shorter duration of urinary catheterization and postoperative hospitalization (p<0.05). The benefits of VH versus AH were shorter operative time, a smaller drop in hemoglobin, shorter duration of urinary catheterization and postoperative hospitalization (p<0.05). The benefits of VH versus LH were shorter operative time, a smaller drop in hemoglobin, and postoperative hospitalization (p<0.05). There were no differences in complications of AH, LH and VH (13.3%, 10.5%, and 9.5%, respectively p=0.825). Conclusions: Eighty six point five percent of hysterectomy can be done vaginal or laparoscopic approach. When there is a concerted effort to increase laparoscopic or vaginal hysterectomy, abdominal hysterectomy can decrease without increasing complication rate.