Gynecology and Minimally Invasive Therapy-GMIT最新文献

Objectives: Robot-assisted surgery has become popular in Japan, especially with the introduction of the da Vinci SP^® surgical system, which is a significant advancement in minimally invasive surgery. The da Vinci SP^® surgical system, which enables single-port surgery, has recently been developed. This study aims to compare the surgical outcomes of conventional single-port laparoscopic surgery and single-port robotic surgery using the da Vinci SP surgical system.

Materials and methods: We included 23 patients who underwent single-port robot-assisted total hysterectomy (SP-RAH) for uterine fibroids and 33 patients who underwent conventional single-port total laparoscopic hysterectomy (SP-TLH). Surgical outcomes from the 1^st year after the introduction of the da Vinci SP^® system were compared between the two techniques.

Results: Surgical outcomes showed the following differences between the SP-RAH and SP-TLH groups: Weights of the resected uterus: 217 (90-500) g versus 256 (100-436) g (P = 0.06); intraoperative blood loss: 12 (4-147) mL versus 80 (10-780) mL (P < 0.01); total surgery duration: 199 (131-251) min versus 239 (110-282) min (P < 0.03); pneumoperitoneal surgery duration: 146 (90-221) min versus 186 (110-282) min (P = 0.03). SP-RAH showed significantly less blood loss and shorter operative durations.

Conclusion: The da Vinci SP system allows the safe introduction of single-port total hysterectomy and improves surgical outcomes in the early stages compared to conventional single-port laparoscopy. Future studies may expand its use to improve wound alignment and reduce patient burden.

Solitary lung metastases more than 10 years after the resection of endometrial carcinoma are a rare occurrence. However, no cases have undergone stereotactic ablative radiotherapy (SABR) for solitary lung metastasis that developed more than 10 years after resection. A 76-year-old woman with a history of endometrial carcinoma 13 years prior was diagnosed with a lung tumor that was confirmed to be a metastasis from the endometrial carcinoma. Due to other health issues, the patient was not eligible for surgery and instead underwent SABR. The treatment was well-tolerated and no adverse events were reported during or up to 2 years after SABR. SABR may be considered as a safe and effective treatment option for lung metastases of endometrial carcinoma that develop more than 10 years after the initial treatment.

Uterine cervical canal stenosis can lead to significant complications, particularly in the context of active clinical tuberculosis. This case study discusses a 25-year-old woman with undiagnosed clinical tuberculosis who presented with amenorrhea and persistent abdominal pain. Further evaluation revealed uterine cervical canal stenosis and frozen pelvis. Surgical intervention was necessary after confirming the diagnosis through clinical assessment. A laparotomy with hysterotomy was performed, during which a Foley's catheter was used to create a patent uterocervical channel. This innovative approach successfully alleviated her abdominal pain and restored her menstrual function. The patient's recovery was smooth, and her symptoms improved markedly. This case underscores the importance of recognizing cervical stenosis as a potential consequence of tuberculosis and demonstrates the effectiveness of surgical treatment in managing complex cases without resorting to hysterectomy or bilateral salpingo-oophorectomy, thereby preserving reproductive potential for women of childbearing age.

Objectives: This study aimed to assess the level of agreement between digital palpation and perineometeric scoring in measuring the strength of PFM. The objective was to ascertain the worth of digital assessment, enabling healthcare professionals to utilize it as a convenient screening and evaluation tool without the requirement of acquiring specialized equipment.

Materials and methods: This study included 435 Indian women between the ages of 18 and 55 years. The researchers evaluated PFMS using digital palpation and perineometeric scoring. Urogenital surgery, incontinence, and a history of pelvic organ prolapse were excluded. The data analysis encompassed demographic variables, the kappa coefficient, Pearson's correlation, and regression analysis.

Results: The average age was 30 years, and the average body mass index was 23.95. The majority of individuals were nulliparous. The assessment of PFMS was conducted satisfactorily, demonstrating a significant level of agreement (κ = 0.63) between digital palpation and perineometeric scoring. The regression analysis provided confirmation of the reliability, with an R-value of 0.954 and an R-square value of 0.910.

Conclusion: It is essential to have dependable techniques to evaluate PFMS in Indian women. The outcomes highlight the need of using standardized evaluation methods and taking demographic factors into account. The low engagement of women, particularly prior to childbirth, in PFM activities highlights the importance of promoting knowledge and understanding. This study enhances the management of pelvic floor dysfunction and underscores the significance of accurate assessment for optimal treatment planning.

Objectives: Minimally invasive surgery (MIS) for cervical cancer is associated with poorer outcomes compared with open surgery. The Laparoscopic Approach to Cervical Cancer trial revealed an increased recurrence and mortality risk after MIS. We aimed to compare the long-term outcomes of laparoscopic radical hysterectomy (LRH) with those of sentinel node navigation surgery (SNNS) and open surgery for cervical cancer, emphasizing techniques to prevent cancer spillages.

Materials and methods: We retrospectively analyzed data from 103 patients with cervical cancer who underwent radical hysterectomy at Kagoshima University Hospital between 2007 and 2023. The patients were divided into the LRH with SNNS and open surgery groups. All LRH procedures involved closing the vagina using a vaginal cuff without a uterine manipulator. Clinicopathological factors and oncological outcomes, including 5-year recurrence-free survival (RFS) and overall survival (OS), were compared between the groups.

Results: The 5-year RFS and OS rates were 92.7% and 94% and 85.5% and 88.3% for LRH and open surgery, respectively, with no significant intergroup differences. No peritoneal dissemination or recurrence was observed in the LRH group. LRH with SNNS procedure achieved 100% sentinel node identification, and lower extremity lymphedema or pelvic lymphocele did not occur.

Conclusion: LRH with SNNS and open surgery for cervical cancer exhibited comparable long-term outcomes. Vaginal closure using a vaginal cuff without a uterine manipulator is crucial for preventing cancer spillage. Combining LRH with SNNS is less invasive and avoids compromising oncological outcomes. High-quality randomized controlled trials are required to validate these findings.

Objectives: Postoperative voiding dysfunction has been observed soon after surgically correcting pelvic organ prolapse (POP) and stress urinary incontinence, but it often resolves after a few months postoperatively. The causes of continued voiding dysfunction after POP repair remain unclear. The present study investigated significant predictors of postoperative prolonged voiding dysfunction.

Materials and methods: The study enrolled 174 patients who underwent surgery for POP at our hospital, including 90 and 84 patients treated with laparoscopic sacrocolpopexy and transvaginal mesh surgery, respectively. Prolonged voiding dysfunction is defined as postvoid residual (PVR) urine volume of ≥100 mL at 3 months postoperatively. Pearson's Chi-squared test and multiple logistic regression analysis were conducted to assess independent factors for prolonged voiding dysfunction.

Results: Pearson's Chi-squared test revealed that patients with PVR of ≥100 mL preoperatively and PVR of ≥100 mL at 2-3 days or 1 month postoperatively, as well as postoperative catheter usage demonstrated a greater association with PVR of >100 mL at 3 months postoperatively. Multiple logistic regression analysis exhibited only PVR of ≥100 mL at 1 month postoperatively as an independent factor for PVR of ≥100 mL at 3 months postoperatively in the multivariate analysis (odds ratio: 42.79; 95% confidence interval: 3.776-484.8405; P = 0.0024).

Conclusion: PVR of ≥100 mL at 1 month postoperatively may be a significant predictor of PVR of ≥100 mL at 3 months postoperatively. Appropriate management should be given to patients with PVR of ≥100 mL at 1 month postoperatively to prevent long-term urinary problems.

Ectopic pregnancy can be mistakenly reported as a ruptured corpus luteum. A 22-year-old woman was initially misdiagnosed with a ruptured corpus luteum and treated with analgesics at a local clinic. Persistent symptoms led her to our hospital, where a pelvic ultrasound revealed a 5.2 cm ×4.8 cm hematoma. Despite the significant hematoma, her vital signs were stable. A urine pregnancy test was positive, β-hCG was 5553 mIU/mL, and hemoglobin (Hb) was 6.3 g/dL. After a blood transfusion, methotrexate (MTX) was administered, reducing β-hCG to 4428 mIU/mL by day 5. Four weeks later, β-hCG was 723.6 mIU/mL, and a second MTX dose was given. Three weeks later, β-hCG was 4.7 mIU/mL, and Hb was 12.4 g/dL. In conclusion, a "wait-and-see" approach with serial hCG testing and repeated ultrasounds is recommended in unclear cases.

Objectives: To analyze clinical outcomes and the factors that influence the therapeutic outcomes of high-intensity focused ultrasound (HIFU) ablation for different types of submucosal uterine fibroids.

Materials and methods: A total of 626 patients without fertility requirements who underwent HIFU ablation for submucosal uterine fibroids at Suining Central Hospital from November 1, 2010, to December 31, 2023, were retrospectively reviewed. The safety and clinical efficacy of HIFU ablation therapy for submucosal uterine fibroids were evaluated.

Results: The patients with submucosal uterine fibroids presented increased menstrual volume in 25.24% (158/626) of patients, prolonged menstrual period in 16.93% (106/626) of patients, lower abdominal pain in 5.59% (35/626) of patients, and anemia in 39.46% (247/626) of patients in this study. The average nonperfused volume ratio of type 0, type I, and type II submucosal uterine fibroids was 89.00%, 88.54%, and 85.33%, respectively. No severe adverse events occurred in any of the patients during or after HIFU treatment. Twenty-five patients received reintervention treatment (HIFU or surgical fibroid resection) in 6 months to 7.28 years after HIFU. A significant difference was observed in postoperative combined treatment between the reintervention and non-reintervention group (P < 0.05).

Conclusion: HIFU ablation for type 0, type I, and type II submucosal uterine fibroids is safe and effective. The combination management mode after HIFU could reduce the chance of reintervention treatment.