Gynecology and Minimally Invasive Therapy-GMIT最新文献

The concept of robotically enhanced surgical anatomy (RESA) has recently been proposed. We concur with the concept of RESA and have been pursuing surgical techniques that benefit from the attribute of robot-assisted surgery. We evaluated RESA and its significance for organ dissection and cavity development in total robot-assisted hysterectomy. Pelvic cavity development and organ dissection can be achieved naturally by applying the appropriate counter traction and carefully dissecting the areolar connective tissue identified by RESA. For uterine parametrial tissue, which is based on the bunching technique, the uterine vessels, including the deep uterine vein, can be readily isolated and ligated through RESA. In some cases, the vaginal vessels can also be isolated and bunching technique can be minimized. Currently, we are striving to perform robotic surgeries that maximize the use of RESA. The following video shows some of the robotic-assisted surgeries that we perform in our department.

Uterine fibroids are benign tumors that originate from the smooth muscle of the uterus. They are often associated with menorrhagia, pelvic pain, infertility, and a sensation of pressure. The symptoms depend on the location of the fibroids, with submucosal fibroids more commonly causing menorrhagia due to their proximity to the endometrium. Meanwhile, intramural and subserosal fibroids typically do not cause excessive bleeding unless they disrupt the endometrial lining. Uterine Fibroid embolization (UFE) is a minimally invasive treatment for fibroids that works by occluding the arteries supplying the fibroids, leading to ischemic necrosis and fibroid shrinkage. This case report describes a 40-year-old female who presented with heavy menstrual bleeding, pelvic pain, and increased urinary frequency due to an endometrial uterine fibroid - for which she underwent a UFE. Follow-up at 3.5 months post-UFE revealed reduced uterine size and menstrual symptom improvement. At one year post-procedure, the patient developed increased pelvic pressure and heavier bleeding compared to her post-UFE baseline. MRI obtained 9 months later displayed a reduction in the size of the fundal fibroid. A new finding of a fistula between this fundal fibroid and the endometrial canal was also observed and confirmed with an in-office hysteroscopy. Conservative management, including iron supplementation, pain control, and serial ultrasound monitoring, resulted in symptom resolution within two weeks.

Objectives: We aimed to evaluate the results of surgery for adnexal torsion at Fukushima Red Cross Hospital over the 10-year period from 2013 to 2023.

Materials and methods: In cases of adnexal torsion, we evaluated the incidence, torsion site, symptoms, and presence or absence of necrosis and bleeding.

Results: Among 1243 surgeries for ovarian tumor performed during the study period, there were 43 cases (3.5%) of adnexal torsion. Of these, 39 cases (91%) were entire ovarian torsion (ovarian and fallopian tube torsion [OFTT]) and 4 cases (9%) were isolated fallopian tube torsion (IFTT). The incidence of ovarian tumors was higher with OFTT, while paraovarian cysts and hydrosalpinx were more common with IFTT. Compared with IFTT, OFTT was associated with more frequent abdominal pain, emergency surgery, and necrosis on pathological diagnosis. Furthermore, in 53% (10/19) of cases with no necrosis on postoperative pathological examination, there was a change in color to dark purple or black that was suspected to represent necrosis during surgery.

Conclusion: Adnexal torsion can lead to necrosis of the ovary or fallopian tube; thus, it is important to make an accurate diagnosis and provide appropriate treatment as soon as possible. When selecting a surgical procedure in reproductive-aged women, it is recommended that ovarian function - sparing procedures be actively considered, except in cases of advanced necrosis, with the understanding that there is often a discrepancy between intraoperative macroscopic necrosis findings and pathological necrosis that identified by postoperative pathological examination (discrepancy rate was 31% in this study).

Objectives: The objective of this study was to investigate the impact of postoperative modified Trendelenburg posture on shoulder pain after laparoscopic hysterectomy (TLH).

Materials and methods: Forty-six patients undergoing TLH for benign gynecologic conditions were prospectively enrolled in a randomized controlled trial with a 1:1 allocation ratio. At the postoperative ward, patients in the intervention group were placed in a modified Trendelenburg posture with a 20° inclination for 6 h, while those in the control group were maintained supine. Shoulder pain was evaluating using a Numerical Rating Scale (NRS) at intervals of 0, 6, 12, and 24 h postoperatively upon admission to the postoperative ward. Additionally, scores for upper abdominal pain, lower abdominal pain, nausea/vomiting, as well as the total consumption of rescue analgesia and antiemetic drugs within the first 24 h following surgery were recorded.

Results: The baseline characteristics exhibited no significant differences between the two groups. Furthermore, when evaluating the NRS of shoulder pain, no statistically significant difference was observed between the two groups (P = 0.363). Additionally, no notable distinctions emerged in the scores associated with upper abdominal pain, lower abdominal pain, nausea/vomiting, or the overall usage of rescue analgesics and antiemetic medications within the initial 24 h following the surgical procedure.

Conclusion: Implementing a modified Trendelenburg posture for a duration of 6 h after TLH did not have a significant impact on reducing shoulder discomfort.

Menopause and obesity are interrelated conditions that collectively increase the risk of cardiometabolic diseases, impair quality of life, and pose challenges to gynecologic care. In menopausal women, hormonal decline facilitates fat accumulation, while obesity exacerbates menopausal symptoms and surgical complications. This review synthesizes current evidence on the pathophysiological interplay between menopause and obesity, evaluates behavioral, pharmacological, and surgical strategies for weight management, and discusses the implications for gynecologic minimally invasive surgery (MIS). A comprehensive literature review was conducted, focusing on clinical guidelines, randomized trials, and meta-analyses concerning obesity management in midlife women. Lifestyle interventions form the cornerstone of obesity treatment, but pharmacologic agents-particularly glucagon-like peptide-1 receptor agonists and dual incretin therapies-have demonstrated superior efficacy in achieving weight loss and cardiometabolic improvements. Bariatric surgery remains the most effective long.term option for severe obesity. Minimally invasive gynecologic procedures, although technically more challenging in obese patients, remain preferable when preoperative weight optimization and multidisciplinary care are applied. A multidimensional, personalized approach to obesity management in menopausal women is critical for improving metabolic outcomes and optimizing surgical safety. Importantly, preoperative optimization of obese menopausal women enhances the feasibility and outcomes of gynecologic MIS, thereby directly addressing a core concern of gynecologic practice. The emergence of novel injectable pharmacotherapies shows great promise and warrants further investigation in this population.