[Global Medical Leader | Field of Obstetrics and Gynecology]

Restoration of uterine health through HIFU and Single-port laparoscopic surgery
Kim In Hyun, Oakwoodbom Clinic chief director | Medical Doctor

The name Oakwoodbom Clinic contains the desire to find "Spring" for women. It focuses on finding women¡¯s uterine health and preserving beauty. It consults and solves various problems that women are related including women¡¯s diseases, skin and body care, and marital relationships. It is the only integrated center for uterine preservation in Korea and protects women¡¯s uterine health. For this outstanding system, there is Kim In Hyun, chief director of gynecology and uterine myoma surgery. For nearly 30 years, he has treated gynecological patients and performed more than 800 HIFU procedures, more than 8,000 laparoscopic procedures, and more than 2,000 single-port laparoscopic surgery.

His job philosophy is simple but clear. That is minimizing extracting the uterus and preserving it. This is because, for women, the uterus has more than a long-term value for pregnancy and has a great impact on mental and physical health. No matter how tricky multiple myomas are, they do not give up and protect the uterus with ¡®Hidan¡¯ which combines HIFU and single port laparoscopic surgery. Recently, patients have undergone laparoscopic surgery using robot cameras as assistance. Today, we will hear a story about Kim, who claims to be a female uterine health protector and provides warm spring to women. Journalists_Lee Na Hyun and Park Jin Ah

The uterus must be preserved and treated in any cases

The womb is the home of the fetus. However, it means more than just generative organs for women. This is because it has a significant impact on women¡¯s mental and physical health regardless of childbirth by itself. There is also a risk of suffering from depression or neurological diseases if uterine health becomes unhealthy. Therefore some people choose to endure the diagnosis even though surgery is necessary. In the meantime, there have been many women who have had uterine extractions for treatment purposes but Director Kim considers the situation of these patients as a top priority when looking at uterine myoma. This is the belief that he will definitely preserve and treat the uterus in any difficult case.

Kim told a patient¡¯s case that triggered him to start preserving the woman¡¯s uterus. She was an unmarried patient in her 40s who had severe anemia due to excessive uterine bleeding caused by multiple myomas while working at Gangnam Cha Hospital. He tried to recover the uterus by removing dozens of myomas one by one after opening the abdomen, but he was forced to remove the uterus due to excessive bleeding during surgery. He reportedly heard that she was notified of the breakup after informing her partner who promised to marry her that she had had her uterus removed.

Seeing a patient in so much pain, he has since vowed to never have uterine removal surgery without an understandable reason. If the patient is my lover or my sister, especially if there is a myoma that causes problems in the uterus, the answer is to preserve the uterus rather than remove the uterus.

Uterine preservation and integration center with customized medical treatment

Kim is the leader in HIFU (High Intensity Focused Ultrasound) in Korea. Based on the results of more than 800 successful procedures, safe treatment tailored to each patient is being performed. Haifu is a method that selectively reduces myomas or adenomyosis by focusing on high-intensity ultrasound energy that is harmless to the human body. It is an effective and excellent way to reduce the size by more than half in giant uterine myoma. Systemic anesthesia is not required, and procedures and discharge are possible on the same day. There is no need for an incision, so there is no scar left. In other words, it is a new medical technology for patients who postpone surgery due to fear and burden of it. However, it will be crucial to choose skilled medical staff because high-level surgery can cause rare damage depending on the doctor¡¯s ability.

Hidan, a new surgical method that combines HIFU and single-port laparoscopic surgery has also been developed. When the size of uterine myoma becomes small first through HIFU and becomes large enough to secure vision after several months, single port laparoscopic surgery is performed. Existing methods operate through three to four small holes, but Director Kim conducts surgery by making only one hole in the navel. Therefore it is evaluated as the most outstanding advanced surgical method among laparoscopic surgeries due to its few scars and short recovery period.

¡°HIFU reduces giant uterine myomas at once and can also address multiple myomas. It can also be carefully applied in cases of adhesion due to laparotomy in the past. Patients who are planning to be pregnant can also remove myoma with a single port laparoscopic surgery without laparoscopic surgery about 6 months after HIFU and medication. The size of myoma that is solved by laparoscopic surgery is solved by a single port laparoscope. Considering the patient¡¯s situation, such as age and family planning, we are providing personalized treatment.¡±

Kim announced in a video session at the ¡®2019 Korean Society of Gynecologic Endoscopy Fall Conference¡¯ that it is possible to operate laparoscopic uterine fibroids after cutting 30-40% of uterine fibroids by doing HIFU first when unmarried women do not want laparotomy.

Expecting the popularization of high-safety, effective HIFU
Kim promotes the development of HIFU and is also an adviser to the Korean Society of Ultrasound in Medicine founded in April 2022. As it has been proven to be an effective new medical technology by the Ministry of Health and Welfare university hospitals are also ordered to actively utilize it. This is because some people are skeptical. After all, HIFU may lead to questions and side effects about the treatment¡¯s effectiveness or the difficulty of its procedures.

He said there were complications in some clinics at the beginning of the introduction but there are few such symptoms due to the recent improvement of HIFU equipment. In addition, he stressed that the results only differ depending on the experience and ability of doctors to treat them. Kim as the representative director of a women¡¯s hospital, started HIFU in 2015 and safely carried out more than 800 procedures. Depending on the patient¡¯s age or symptoms, treatment may be completed only with HIFU and laparoscopic surgery is possible after reducing the size so it will be a necessary procedure first.

Nowadays university hospitals have expressed regret over the reality that women in their 40s, who completed family plans, remove the uterus if a woman have uterine myoma after menopause. Some statistics show that Korea is one of the most common countries for uterine myoma or adenomyosis. He also regretted having a lot of hysterectomies as he learned during his time as a professor. He argued that such a trend in university hospitals still needs to be changed.

¡°Recently I saw a consultation letter from a member of the society that was written by a professor of obstetrics and gynecology at a university for non-payment of insurance on HIFU treatment. The opinion was that drug treatment or cervical surgery should be prioritized in 12cm-tall submucosal myoma, followed by arterial embolization and HIFU as the third. Also, I was enraged to see the opinion that watching the progress was sufficient as the patient¡¯s menopause was just around the corner. When I looked at the chart, it was already over 12cm in size with multiple myoma.¡±

¡°I have sent an objection. The patient¡¯s main symptoms are abdominal compression, constipation, frequent urine, urinary incontinence, pelvic pain, and varicose veins of the lower extremities. Non-invasive HIFU is the number one new medical technology that solves these problems caused by huge uterine myomas in a short period of time. I conveyed that the advice of the university professor that HIFU is not paid and the treatment effect is not recognized is wrong even though the patient and the doctor agreed with each other and gave reasonable treatment.¡±

HIFU can solve huge size and multiple fibroids

Director Kim¡¯s source of confidence is the numerous clinical cases accumulated so far. Among patients, most of them came by inquiring about their names after being diagnosed at a university hospital that there was no treatment other than uterine extraction.

¡°When I served as the head of Cha Women Hospital in Daegu, a patient had cervical cancer and had her uterus removed, but she came to see me because he desperately wanted a baby. I asked her to find a surrogate, but she couldn¡¯t. After discussion, the patient¡¯s mother (57 years old at the time) who became menopause was designated as the surrogate mother, proceeded with pregnancy, and gave birth by cesarean. This is an example of how a woman¡¯s womb is worth preserving until she dies through the fact that the menopausal uterus can also be pregnant.¡±

The 45-year-old unmarried woman he treated in 2017 had severe urinary frequency and cramps. Ultrasonography revealed a 10cm huge myoma on the back wall of the uterus. According to the diagnostic laparoscopy, the large intestine and abdominal wall were tightly adhered to as a result of emergency surgery 20 years ago. Laparoscopy was no longer possible, and laparotomy was impossible to remove the myoma. He therefore explained to the patient and spouse the need for HIFU and implemented it. He successfully completed the HIFU procedure without complications. Each month after discharge, the uterine myoma gradually decreased to 5cm by 6 months, confirming the excellent treatment effect that no longer requires surgery.

¡°Whenever patients who have heard pessimistic stories such as the need for uterine extraction or laparotomy because of adhesion, come to me with a last hope, I have a greater will to challenge. What I emphasize is that doctors should be responsible for the patient.¡±

Laparoscopy through robot camera

Director Kim is said to have learned about laparoscopy when he worked at Gangnam Cha Hospital in 1995. Dr. Lee Jung No (Vice Chairman of Cha Group), an authority on urinary incontinence surgery, who served as president of the Korean Urogynecologic Society, has extensive clinical experience in laparoscopic and urinary incontinence surgery. He has since taken the lead in a new laparoscopy. Director Kim was the first person who attempt ¡®live laparoscopic hysterectomy¡¯ with laparoscopy in Korea, and also the first to perform live single port laparoscopic hysterectomy.

Recently, for gynecological surgery, laparoscopic surgery has been performed for the first time in Korea with a robot camera as an aid. This is a new medical technology that performs the surgery by adjusting the angle or position of the robot camera with a manipulation device worn on the head by a doctor. At the same time, the auxiliary robot holds the camera. Since February this year, more than 40 cases have been successfully conducted. This will help the management of women¡¯s hospitals and can reduce the burden of actual insurance on patients.

Currently, many hospitals recommend the da Vinci surgical system for laparoscopic surgery. It is a surgery that does not apply to health insurance and is covered by actual medical expense insurance. Usually, it causes an economic burden with surgery costs between 10 million and 20 million won. The method performed by Director Kim has no difference in sophistication or effectiveness compared to the existing da Vinci surgical system. On the contrary, da Vinci requires three surgical parts, but Kim needs only one single port laparoscopic surgery, leaving only a fine scar on the navel. In addition, in recognition of new medical technology, actual medical expense insurance claims can be made with accepted non-reimbursement.

¡°Da Vinci surgical system requires an assistant to insert a robotic arm or instrument after a doctor has drilled a hole in the patient¡¯s abdomen, and the doctor sits on the console and performs the operation remotely on a 3D image that magnifies the inside of the human body. On the other hand, I use a free-hand panoramic robot camera to perform laparoscopic surgery directly on the patient¡¯s stomach. Subject to medical care benefits approved by the Health Insurance Review & Assessment Service and the Ministry of Health and Welfare around September 2022, it is a surgical method that can reduce the burden on women¡¯s hospitals and patients.¡±

Beginning as a stem cell therapy center

The stem cell treatment center is conducting a higher level of treatment using stem cells. Stem cells are undifferentiated cells that can develop into cells of various tissues that make up the human body. It is expected to be the core of future medical care due to its endless capabilities such as strengthening immunity, improving liver function, strengthening regeneration, and delaying aging.

Oakwoodbom Clinic is equipped with Miracel¡¯s state-of-the-art regenerative medical bio device named Smart M-cell 2 and uses stem cells to treat hair loss, plastic surgery, and recently treated knee arthritis. And all of these are able to be covered by actual insurance. The device extracts a large amount of stem cells automatically separated by centrifugation and concentration with minimal manipulation. With this patented technology, a system has been established that can safely use living cells without cultivating stem cells and genetic modification. This is directly injected into areas to be solved such as the scalp with alopecia or skin aging.

In particular, the Oakwoodbom Clinic uses all of the SDF-1 alpha, white blood cells, platelets, growth factors, and stem cells that are essential for the regeneration of adult stem cells. SDF-1 alpha is a protein signaling material that moves stem cells to the necessary area and plays a role in enhancing the regeneration effect of stem cells. Because it is a pluripotent stem cell, it generates new cells to replace cells killed by external shock or aging. Stem cells contain growth factors that promote hair root cell division, which quickens hair growth. There is no difficulty in daily life after the procedure.

¡°The equipment named ¡®Smart-M-cell 2¡¯ that Miracell launched is a safety-certified stem cell and immune cell treatment system. The degree of recovery is high as 400 million stem cells are produced from 120cc of blood. It has already conducted several clinical trials with many hospitals in Korea, and its effectiveness in stem cell regeneration is highly appreciated. I heard that Severance Hospital is also undergoing clinical trials to treat vascular dementia by injecting stem cells into the carotid.¡±

As such, it plans to gradually develop into a clinic that treats stem cells. In addition, it aims to establish itself as a clinic that informs stem cells for overseas medical tourists visiting Korea.

From checkup to diagnosis by responsible professional medical staff

Oakwoodbom Clinic is a 17792-square-foot clinic that can complete diagnosis and treatment of the disease in one place. In addition to the reservation medical service, comprehensive medical check-ups are also provided. It is located on the first basement floor of the Oakwood Hotel, which connects the COEX Center in Samseong-dong and the airport terminal, making it accessible to customers. Due to its location strength, it is the only cooperative clinic with GKL (casino) and many foreigners receive medical treatment. In the future, it plans to be reborn as a clinic that provides customized treatment for checkup, diagnosis, and treatment. It will provide medical treatment in all fields except pediatrics. Through this, it is expected to become the family doctor of numerous office workers working in COEX Mall.

Professional medical staff with long clinical and treatment experience are presented in each field of obstetrics and gynecology, thoracic surgery, internal medicine, and plastic surgery. Choi Soo-hee, director of obstetrics and gynecology, has 20 years of experience from Seoul National University and performs filler/tissue regeneration and painless surgery based on detailed consultation in the fields of ¡ã feminine function ¡ã gynecological urinary disease ¡ã vaginal and labia minora plastic surgery. Individual customized procedures are constantly being conducted with the latest equipment to promote HIFU of uterine myoma and vaginal collagen regeneration.

Moreover, Director Han In-kwon served as the head of the Endocrinology Research Institute at Samsung Medical Center. He is a famous doctor in the field of thyroid who was once widely known as the first lady¡¯s family doctor. High-frequency ablation focuses on preserving the thyroid with little pain. Director Lee Seung-hwan of internal medicine has had a long career as the head of the Severance Health Examination Center. He also worked at the digestive center at Asan Medical Center and the Heart Center at Cleveland Hospital. As such, he has been doing a lot of treatment and research related to respiratory diseases and seeks a perfect cure.

At the varicose vein clinic, Choi Kang-Joo, a cardiothoracic surgeon from Asan Medical Clinic in Seoul with 30 years of experience will provide detailed treatment. The varicose veins complain of symptoms such as protruding blood vessels or changes in color and pain throughout the legs, and soles of the feet, hips, and back. These symptoms occur easily in women after menopause. The number of patients is increasing due to the first success of heart transplant surgery in the province and the cure of varicose veins. Plastic surgeons Lee Sun-Jae and Cha Seung-Yeon have a long career in non-surgical cosmetic procedures, eye, nose, and mouth plastic surgery, and breast reconstruction surgery.

Performance of the steward¡¯s duty with the given ability

Director Kim is a Christian. The purpose of the opening was explained as a metaphor for the master who gave the servants of the Bible Matthew 25:14 to 40. The master leaves the property to three servants and goes on a trip. One servant was given five talents, the other two talents, and the last servant one talent. The first and second servants use their given talents to invest and thrive. On the other hand, the last servant only hides and preserves a given talent in the ground. The master returns and compliments the first and second servants for their good work. However, the third servant has lost even a talent to his master, who gives it away to two he praised and then drives him out. This metaphor emphasizes the need to utilize and practice the individual¡¯s talents received through faith. It contains a lesson that the given abilities and resources should be doubled rather than wasted indifferently.

Director Kim is said to open and grow a clinic by maximizing the gynecological skills he has learned with a mindset that it is like taking care of the steward¡¯s job received from the master. In addition, as a director of the Korea Campus Crusade for Christ (CCC) in Busan and Daejeon, it is selected as a designated hospital through the CCC agreement. He provides medical benefits and missionary expenses to the assistant administrator and immediate family members who need health checkups and medical treatment in that group.

¡°We all get a talent in life. It¡¯s a young realization that we all have to try and expand that talent and use it for our neighbors in need. I also began to believe in Jesus when I was a university student and I am supporting university students with the fruition of medicine. Therefore if a university student received a scholarship of 1 million won, I would like to help an open-minded and sincere university student who can enter social life later and give a scholarship at double the amount to other future students.¡±

Advice for the future of obstetrics and gynecology in the low birth rate era

Director Kim also left advice, regretting the reality faced by the obstetrics and gynecology department. This is because the future of obstetrics and gynecology is bleak, just as the women¡¯s hospital which recently worked hard enough to birth more than 80,000 cases in Ulsan for a long time, closed at the end of August. It is also difficult to obtain medical staff in obstetrics and pediatrics.

According to 2017 statistics from the Health Insurance Review and Assessment Service, the number of patients with uterine myoma among women is gradually increasing. Compared to four years ago, the number of patients with uterine adenomyoma increased by 26%, and the number of patients with uterine myoma increased by 60%. In addition, women who suffer from menstrual pain and excessive menstruation in their daily lives should visit a gynecological clinic to find the cause. Kim is constantly researching and trying to grow into a clinic that comes after hearing that he is good at diagnosing and treating such women¡¯s diseases.

Finally, ¡°I hope it will be a hospital recognized as a uterine preservation and integration center that finds uterine health. We will diagnose the symptoms or diseases that women have worried about on their own and make it a healthy uterus. In addition, the Oakwoodbom Clinic will help families who have struggled with female patients to face a warm spring after a cold and harsh winter by ensuring that uterine fibroids are well treated,¡± Kim said.