Successful endoscopic operations in benign gynecologic diseases: experiences of 6,017 cases

Kim, Tae Wan; Moon, Hwa Sook; Kim, Hyun Jeong; Kim, Sung Hee; Cho, Young Rok; Choi, Jin Kook; Park, Gun Sik; Kim, Sang Gap

Abstract

OBJECTIVE
The purpose of this study is to evaluate the application rate and effectiveness of endoscopic operations based on 6,017 cases in the field of gynecology.
METHODS
Six-thousand-seventeen cases of endoscopic operations were performed from March 1993 to June 2004 in the department of Obstetrics and Gynecology, Center for Endoscopy, Good Moonhwa Hospital. Endoscopic operations were done on the majority of patients who had benign gynecologic diseases. We applied "two-surgeons system" and simplified methods of operation consisted of endoloop-ligation, endosuture and endotying.
RESULTS
Our endoscopic operations were successful in 5,994 cases (99.62%) out of 6,017 attempts. Twenty-three cases (0.38%) were converted to laparotomy due to severe pelvic adhesion, excessive bleeding or difficulty in accessibility. In the first year endoscopic operations were done in 29.0% of the total gynecologic operations, but was increased to 52.9% during the next 4 years. In 2003, 93.0% and in 2004, 99.0% of the total gynecologic operations were done by endoscope. While the simple technique surgeries showed a high application rate, the more complicated technique surgeries, which began at a lower rate, showed a steady increase up to 89.3%. Blood loss and operation time were markedly declined during 3 year period and maintained at a low level thereafter. A 3 years' period of endoscopic operations (about 500 cases) is necessary for a hospital learning curve while, 26.4 cases is necessary an individual surgeon's learning curve. The major complications during the study period was 28 cases (0.47%).
CONCLUSION
Endoscopic operations can be applied in almost all benign gynecologic diseases. In particular, "two-surgeons system" is a safe method with few complications and minimal learning period. These results suggest that if appropriate techniques could be learned, endoscopic operation might be preferred to laparotomy for both surgeons and patients.