https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/234 2026-04-04T16:12:57Z https://scholarworks.korea.ac.kr/kumedicine/handle/2021.sw.kumedicine/64083 Title: Change of anti-Mullerian hormone (AMH) value for ovarian reserve after minimal invasive benign ovarian cystectomy: Da Vinci robotic system (Xi and SP) and laparoscopic system. Authors: Park, Y.; Han, H. J.; Oh, Y.; Bae, N.; Oh, S.; Shin, J. H.; Kim, Y. J. Abstract: Study question To investigate impact on ovarian reserve after minimal invasive ovarian cystectomy using two platforms; Da Vinci robotic system (Xi and SP) and laparoscopic system. Summary answer Benign ovarian cystectomy using Da Vinci robotic system takes a long time, but it is an effective minimally invasive method to preserve ovarian function. What is known already With the development of minimally invasive surgical methods such as laparoscopic and robotic system, patient satisfaction has increased not only in terms of pain relief but also cosmetic aspects such as smaller scars. Protection of ovarian function during surgery is important in terms of fertility preservation, and this should be considered first in minimally invasive surgery. Serum anti-Müllerian hormone (AMH) is a widely used index to evaluate ovarian reserve. Study design, size, duration This study included patients who underwent laparoscopic or Da Vinci robotic (Xi or SP) ovarian cystectomy for benign ovarian cysts between January 1, 2018 and September 30, 2022 at a single institution. A retrospective study was conducted through electronic medical chart review. Participants/materials, setting, methods A total of 128 patients were enrolled. Among them, 71 patients underwent laparoscopic surgery and 58 patients underwent robotic surgery. The preoperative AMH value was determined as the value within 4 weeks before surgery, and the postoperative AMH value was determined as the value from 1 month after surgery to within 1 year after surgery. The AMH change value (ΔAMH) was expressed as a percentage value; (postAMH – preAMH) x 100 / preAMH Main results and the role of chance There was no significant difference in preoperative age, BMI, parity, cyst size, and cyst position ratio. Estimated blood loss during operation, Hb drop, length of hospital day, adhesion detachment rate, and cyst rupture rate also showed no difference. However, the operation time was significantly shorter in the laparoscopic group. (68.51±30.99 minutes vs. 105.17±38.87 minutes, p < 0.01) The mean preoperative AMH was significantly higher in Da Vinci robotic system than laparoscopic system. (5.89±4.81 ng/mL vs. 4.02±3.61 ng/mL, p = 0.02) The mean postoperative AMH was also higher in Da Vinci robotic system. (4.31±3.34 ng/mL vs. 3.02±2.64 ng/mL, p = 0.02) But, the mean ΔAMH was not significantly different between two groups. (-19.55±40.67 % in laparoscopic system vs. -19.95±38.79 % in robotic system, p = 0.96) When the robot groups were divided into Xi system (N = 21) and SP system (N = 37) and compared, but ΔAMH did not show significant differences among the three groups. (-19.55±40.67 % in laparoscopic system vs. -14.63±47.80 % in Xi system vs. -22.97±32.97 % in SP system, p = 0.75) Even in the patient group with preoperative AMH below 2, ΔAMH was -9.50±57.58 % in the laparoscopic system (N = 20) and -11.72±60.92 % in the robotic system (N = 11), showing no significant difference between the two groups. (p = 0.92) Limitations, reasons for caution A limitation of this study is that the measurement period of AMH was set within a wide range within 1 year after surgery. In addition, the small sample size when divided into two systems, SP and Xi, is also a limitation. Wider implications of the findings Compared to the existing laparoscopic system, the robotic system does not show a significant difference in protection of the ovarian reserve, so it will be widely selected as an option for minimally invasive surgery. 202306-01-01T00:00:00Z https://scholarworks.korea.ac.kr/kumedicine/handle/2021.sw.kumedicine/64415 Title: KGOG2031 A phase II trial of repeated high dose luteal hormone therapy for intrauterine recurrence following fertility preserving therapy for atypical endometrial hyperplasia or endometrial cancer Authors: Kim, Min Kyu; Ouh, Yung-Taek Abstract: Background: Atypical endometrial hyperplasia (AEH) and early endometrial cancer (EEC) are common disease in menopausal women, however, are gradually increasing in women aged under 40 years. The standard treatment for AEH/EC is hysterectomy, but hormonal therapy is performed for preserving fertility. In general, fertility-preserving treatment is considered for AEH or EEC with well-differentiation and lesions confined to the endometrium without myometrial invasion. According to previous studies, hormonal therapy in these patients responded relatively well. Nevertheless, recurrence was not uncommon, accounting for 26.0% in AEH and 40.6% in EC. The standard treatment for these recurrent patients is hysterectomy, but if there is no myometrial invasion and no extrauterine lesions, repeated hormonal treatment can be considered. However, studies targeting these patients have been very scarce. The purpose of this study was to evaluate the efficacy and safety of high-dose progesterone therapy in recurrence following fertility preserving therapy for AEH or EEC. Methods: KGOG2031 is a multi-center and prospective phase 2 trial. The primary endpoint is a 2-year disease free survival. The secondary endpoints were duration of disease-free survival, overall survival, response rate, adverse events, and infertile rates. Patients with recurrent AEH or EEC without myometrial invasion or extrauterine lesions who underwent high-dose MPA therapy for primary lesions were included. The inclusion criteria are limited to patients with less than two recurrences. The pathologic type for EEC was confined to endometrioid type. The patients should be confirmed histologically at least one complete remission after first treatment. Patients with myometrial invasion, cervical involvement, or extrauterine lesions observed on abdominal/chest computed tomography or pelvic magnetic resonance imaging were excluded. Furthermore, grade 2 or 3 of endometrioid or any grade of other pathologic type of endometrial cancer or non-atypical endometrial hyperplasia were excluded. The enrolled patients should take medroxyprogesterone acetate 500mg every day. D&CB will be performed after anesthesia every 8 weeks to determine the effectiveness, and treatment will be continued for up to 40 weeks until complete remission is achieved. The target number of enrollment is 115 cases, and the recruitment period is 3 years. The follow-up duration is 2 years after the end of treatment, and the total study duration was up to 5 years. 20230414-01-01T00:00:00Z https://scholarworks.korea.ac.kr/kumedicine/handle/2021.sw.kumedicine/64067 Title: Construction of 3D Endometrium System for the Receptivity Authors: Kim, Yoon Young; Kim, Yong Jin; Han, Jiyeon; Kim, Sung Woo; Kim, Hoon; Ku, Seung-Yup Abstract: Introduction: Endometrium (EM) is a multi-layered organ, consisting of a functional and basal layer that covers the myometrium. It is known that preprogrammed growth factors and adhesion molecules have been activated by the endometrium or embryo and it induces to form of a receptive endometrium, decidua. Several studies were conducted to elucidate the regulators of the transition, however, embryo-endometrium crosstalk is difcult to accurately observe in the 2D environment. In this study, we investigate the optimal 3D endometrium in vitro-producing condition by comparing the cell and alginate ratio and EM viability. Methods: Endometrium cells (3.75x10^7) from nine-week-old female C57BL/6 were cultured and further mixed with or without 3D gel made of alginate. The alginate and endometrial cells were mixed at ratios of 1:1, 2:1, and 3:1 and cultured for up to nine days. Cell viability was analyzed by the WST method to defne cell survival rate. Attachment and invasion of mouse blastocyst were analyzed by expression of Oct4. Results: Embedded endometrial cells survive up to nine days and cell viability of each alginate-EM mixture was higher in 1:1 and 2:1 with no signifcant diference. The diferent ratio of the alginate-EM mixture results in diferent stifness, which critically afects the survival and invasion of the embryo. The ratio of the alginate-EM mixture at 1:1 and 2:1 successfully supports the survival and invasion of the embryos, however, not at 3:1. Conclusion: Taken together, this study demonstrated that a 3D endometrial system could be applied as artifcial endometrium for the study of embryo-endometrium crosstalk. Further studies are necessary to fnd the expression and secreting of factors during endometrial-embryonic interactions in a 3D culture system (2020R1F1A1076286 and 2021R1F1A1060218). 202303-01-01T00:00:00Z https://scholarworks.korea.ac.kr/kumedicine/handle/2021.sw.kumedicine/62851 Title: Pregnancy outcomes of women with congenital heart disease in South Korea: a nationwide cohort study Authors: Lee, Kyung A.; Park, Mi-Hye; Oh, Min Jeong; Cho, Geum Joon Abstract: Objective To assess pregnancy outcomes of women with congenital heart disease Study Design This nationwide cohort study used data from the National Health Insurance Corporation (NHIC) in South Korea from January 1, 2012, and December 31, 2020. We included all Korean women who had more than one delivery during the study period and had been identified with adult congenital heart disease (ACHD) using diagnostic codes within 1 year before delivery for an outpatient or inpatient. Primary outcomes included maternal composite morbidity (preeclampsia, gestational diabetes, placental abruption, placenta previa, stillbirth, preterm birth, postpartum hemorrhage) and neonatal morbidity (low-birth-weight infants, large-for-gestational-age infants). Results The 2,911 women with ACHD (0.11%) included in the analysis of maternal outcomes had significantly higher odds of maternal morbidity compared with women without ACDH (n=2,663,588). The maternal composite morbidity showed higher odds in women with ACHD (one or more: aOR, 1.324 [95% CI, 1.1.216-1.442]; one: aOR 1.262 [1.154-1.380]; two: aOR 1.593 [1.292-1.965]; three or more: aOR 2.023 [1.086-3.767]). Women with ACHD had significantly higher odds of preterm birth (aOR, 2.218; 95% CI, 1.804-2.726) and low birth weight (LBW) infants (aOR, 1.331; 95% CI, 1.164-1.522). The frequency of stillbirth was not different between women without ACHD (0.02%) and those with ACHD (0%). Conclusion With help of exact prenatal and postnatal diagnosis and advanced surgical and/or medical treatment, women with ACHD who survived could have healthy pregnancies. However, the risk of preterm birth and maternal morbidity is still higher in women with ACHD. Therefore, optimal clinical care should be considered to reduce the heightened risks of ACHD. 202301-01-01T00:00:00Z