Tissue injuries after single-port and multiport laparoscopic gynecologic surgeries: A prospective multicenter study.

The present study focused on the degree of tissue injury following single-port laparoscopic surgery (SPLS) and multiport laparoscopic surgery (MPLS) for the treatment of various benign gynecologic diseases. A total of 228 patients were prospectively enrolled at seven academic centers in South Korea between April 2011 and September 2012. Of these, 122 patients underwent SPLS and 106 patients underwent MPLS. The serum levels of C-reactive protein, creatine phosphokinase, lactic dehydrogenase and cancer antigen 125 were measured preoperatively and on postoperative day 4 by immunonephelometry. Cosmetic satisfaction and postoperative pain scores (visual analogue scale) were analyzed. Postoperative changes in the levels of the serum markers were found to be similar between the SPLS and MPLS groups. However, the postoperative pain scores at 48 h were significantly lower in the SPLS group when compared with those in the MPLS (P=0.001). In addition, patient-controlled analgesia was used more frequently by patients in the MPLS group (P=0.003). The present study is the first prospective investigation of tissue injury resulting from SPLS and MPLS in gynecology. In conclusion, the current study demonstrated that serum marker levels during SPLS were similar to those during MPLS in the treatment of benign gynecologic diseases. However, SPLS is a reasonable alternative to MPLS and is associated with comparable tissue injury, improved cosmesis and reduced postoperative pain.

Embolization for pelvic arterial bleeding following a transobturator tape procedure.

The transobturator tape (TOT) procedure was devised to reduce morbidity, but nevertheless, it may cause significant complications. We treated a patient by pelvic arterial embolization due to severe arterial bleeding following the TOT procedure. The patient presented with vaginal bleeding and hematoma after the TOT procedure. She demonstrated bleeding from the left internal pudendal artery and was treated successfully by selective embolization. Although the risk of arterial injury during the TOT procedure is rare, pelvic surgeons should consider the possibility. Angiography with embolization should be considered for treatment of pelvic arterial bleeding following the TOT procedure.

Effect of human papillomavirus genotype on severity and prognosis of cervical intraepithelial neoplasia.

OBJECTIVE: This study evaluated the effect of the specific human papillomavirus (HPV) genotypes on severity and prognosis in cervical intraepithelial neoplasia (CIN) patients. METHODS: The medical records of 446 patients treated with loop electrosurgical excision procedure (LEEP) were reviewed. The severity of CIN was categorized as CIN1/CIN2 versus CIN3+ including CIN3 and carcinoma in situ (CIS). HPV genotypes were categorized as 1) low risk, 2) intermediate risk, 3) high risk/HPV 16, 4) high risk/HPV 18, and 5) unclassified. Progression was defined as abnormal cytology, including atypical squamous cells, low-grade squamous intraepithelial lesion and high-grade squamous intraepithelial lesion. The margin status and progression free survival (PFS) by HPV genotypes were analyzed in 355 women with three months or more of post-treatment records. RESULTS: CIN3+ was the most common CIN type (67.7%), and high risk/HPV 16 (26.9%) was the most common genotype. Intermediate risk (P < 0.01), high risk/HPV 16 (P < 0.01) and high risk/HPV 18 (P < 0.01) were significantly more common in women with CIN3+ than CIN1/CIN2. Patients with high risk/HPV 18 showed the highest rate of positive margins (P < 0.01). The margin status proved to be the only statistically significant factor affecting PFS. CONCLUSION: The proportion of positive margins was significantly different by HPV genotypes and highest in high risk/HPV 18 group. CIN patients with high risk/HPV 18 need to be more carefully tracked than patients with the other HPV genotypes.

The effect of oral and IV ramosetron on postoperative nausea and vomiting in patients undergoing gynecological laparoscopy with total intravenous anesthesia.

PURPOSE: Ramosetron can be administered orally as well as intravenously. We investigated the effect of oral ramosetron on postoperative nausea and vomiting (PONV) in patients undergoing gynecological laparoscopy. METHODS: One hundred and twenty women were allocated randomly to one of three groups (n = 40 in each) to receive saline (control), 0.1 mg oral ramosetron (PO), or 0.3 mg IV ramosetron (IV). Total intravenous anesthesia (TIVA) with propofol and remifentanil was used in all patients. RESULTS: The incidence of complete response (no PONV, no rescue) in the control, IV, and PO groups was: 65%, 90%, and 87.5%, respectively, during the first 1 h; and 67.5%, 87.5%, and 80%, respectively, during 1 to 24 h. CONCLUSION: The effect of oral ramosetron 0.1 mg was comparable to that of IV ramosetron 0.3 mg on the prevention of PONV in women undergoing gynecological laparoscopy with TIVA. Both the oral and IV forms were effective at preventing PONV during the first 1 h after surgery.