We compared results using unidirectional barbed sutures and conventional sutures for vaginal cuff closure during total laparoscopic hysterectomy (TLH).The electronic medical records and surgical videos of 170 patients who underwent TLH between January 2013 and March 2015 at Uijeong-bu St. Mary's Hospital of Catholic University of Korea were reviewed. Vaginal cuffs were closed using the 2-layer continuous running technique with unidirectional barbed sutures (V-Loc; Covidien, Mansfield, MA) in 64 patients and with polycolic acid Vicryl; Ethicon, Somerville, NJ sutures in 106 patients. Procedure time, clinical characteristics, and postoperative complications were compared between the 2 study groups. There were no differences in clinical characteristics (age, body mass index, and demographic data) between groups. The mean suturing time was significantly reduced in the barbed group (7.2 vs 12.2 minutes; P < 0.001), although the mean number of stitches was greater than in the Vicryl group (14.1 vs 12.3, P < 0.001). Perioperative complications, including episodes of vaginal bleeding, vaginal cuff cellulitis, and postoperative fever, did not differ between groups. There were no instances of vaginal cuff dehiscence in either group. Unidirectional barbed sutures can be used safely to reduce procedure time and surgical difficulty relative to conventional sutures in laparoscopic vaginal cuff closure.

To evaluate the effect of bisphenol A (BPA) on gene expression changes in uterine myometrium, uterine smooth muscle cells were incubated with 2.28 ng/mL BPA for 48 h. Total RNA was extracted and quantified spectrophotometrically. Gene expression changes were analyzed using oligonucleotide microarray hybridization comparing the treated and control groups (1.5-fold change, p⁄ ⁄0.05). Data indicated that 560 genes were upregulated and 231 were downregulated in response to BPA exposure. The biological processes positively associated with gene upregulation included the regulation of cell differentiation, cellular metabolic processes, cell proliferation and smooth muscle contraction. In contrast, genes involved in mitosis, lipid metabolism, regulation of muscle cell differentiation and cell adhesion were significantly downregulated. In the KEGG pathway analysis, MAPK signaling pathway, insulin signaling pathway and extracellular matrix (ECM)-mediated interactions were positively associated with gene upregulation. Results Gene Expression Profiles Induced by BPA in Uterine Smooth Muscle CellGene expression changes were analyzed by comparing the treated and control groups using statistical criteria (1.5-fold change, p⁄0.05). Three independent samples were analyzed. Results indicated that 560 genes were upregulated in response to BPA exposure and 231 were downregulated.The 560 upregulated and 231 downregulated genes were classified according to the GO terms of biological processes and KEGG pathway analysis, to investigate the molecular mechanisms related to BPA exposure. EASE analysis (http://david.abcc.ncifcrf.gov/) was also performed. The key biological processes that were significantly affected (Fisher's exact test, p⁄

Aims: The objective of the current study was to evaluate the efficacy and feasibility of fibrin sealant (Tisseel®) in the loop electrosurgical excision procedure (LEEP) for cervical intraepithelial neoplasia (CIN 2 or 3). Methods: We designed a single-blind, prospective, randomized study in 40 consecutive women undergoing LEEP for CIN 2 or 3 at our institute. Two milliliters of fibrin sealant (Tisseel) was applied to the uterine cervix of 20 women immediately after LEEP surgery (treatment group). We evaluated abdominal pain, vaginal bleeding, vaginal discharge and impairment in daily living after 1 week using visual analogue scale questionnaires and compared the results with those of 20 women who did not receive fibrin sealant (control group). Results: Among 40 women who returned for a follow-up 1 week after LEEP, 25 women (62.5%) reported at least one moderate to severe postprocedural symptom. The mean duration of moderate to severe vaginal bleeding and impairment in daily living during postoperative week 1 for the treatment group and the control group was 0.3 ± 0.80 versus 1.7 ± 2.36 days (p = 0.015) and 0.9 ± 1.37 versus 3.00 ± 2.62 days (p = 0.060), respectively. Conclusion: Intraoperative application of fibrin sealant (Tisseel) in LEEP can decrease postoperative vaginal bleeding and impairment in daily living.

Endometriosis is defined by the presence of endometrial glands and stroma outside uterine cavity showing variable clinical symptoms under effect of estrogen. The occurrence rate of abdominal wall endometriosis after cesarean section is rare making diagnosis difficult. The case of a 36-year-old female presenting with the very painful mass and pain arising in the caesarean section scar is reported. The curable treatment of abdominal wall endometriosis is the surgical removal of all the pathological tissue, through a large excision. The involved fascia was widely excised and the abdominal wall was reconstructed using polypropylene mesh.

The foreign bodies in vagina cause intense inflammation. Genital complaints in patients could indicate the presence of a vaginal foreign object. Vaginal bleeding and blood-stained, foul-smelling discharge are considered to be the main clinical manifestations of vaginal foreign bodies, and toilet tissue reported as the most commonly found foreign body. The insertion of foreign bodies into the vagina is not uncommon but presentation as lower abdominal pain in an gynaecological clinic is rare. The causes of insertion are sexual stimulation, sexual abuse, accident of post-surgery and most cases find a solution after vaginal speculum examination. We describe a case of foreign body in the vagina of a patient presenting with chronic lower abdominal pain but undetectable and unrecognized in general examination.