Gynecology and Minimally Invasive Therapy-GMIT最新文献

The levonorgestrel intrauterine system (LNG-IUS) is used by patients for dysmenorrhea, but cases of uterine perforation have been observed. This patient underwent replacement 5 years after the initial LNG-IUS insertion, but persistent abdominal pain led to a visit to her previous gynecologist. Transvaginal ultrasonography and magnetic resonance imaging (MRI) at the time of the visit did not detect LNG-IUS. A subsequent computed tomography (CT) scan clearly showed the entire T-shape of the LNG-IUS on the sagittal plane and revealed the presence of the LNG-IUS in the abdominal cavity. Laparoscopic observation revealed that the adhesion of the LNG-IUS was mild, and it could be removed without damaging other organs. The patient was discharged without problems on the third postoperative day. LNG-IUS extraction via ultrasonography and MRI is considered challenging due to its material characteristics. We report a case of intrabdominal LNG-IUS migration where CT and X-ray proved useful in the localization of LNG-IUS.

Congenital cervical and vaginal atresia in the presence of a functioning endometrium is an extremely rare disease. Cervicovaginal reconstruction preserves fertility for these patients. We present the case of a 20-year-old patient who had cervicovaginal reconstruction 7 years ago due to congenital cervical and vaginal aplasia. However, with the cervical catheter falling off this year, this patient had severe dysmenorrhea and was diagnosed with cervical restenosis. Finally, this patient was successfully treated with laparoscopic cervical reconstruction. Restoring the continuity of uterus-cervix-vagina for cervical restenosis after cervicovaginal reconstruction is feasible. After cervicovaginal reconstruction, the placement time of the cervical catheter should be extended appropriately to avoid cervical restenosis.

Objectives: Numerous studies have compared robotic sacrocolpopexy (RSC) and laparoscopic sacrocolpopexy; however, comparisons of RSC with the hinotori™ surgical robot system (SRS) are limited. This study aimed to compare surgical factors and outcomes of RSC using the hinotori™ SRS and da Vinci® Xi for pelvic organ prolapse.

Materials and methods: A retrospective analysis was conducted on 80 patients who underwent RSC at Kagoshima University Hospital between January 2017 and June 2024. Patients were divided into two groups based on the robotic system used: hinotori™ SRS (n = 22) and da Vinci® Xi (n = 58). Surgical factors, including operative time, cockpit/console time, blood loss, length of hospital stay, and complications, were evaluated.

Results: The median operative time and cockpit/console times for the hinotori™ SRS were 286 (range: 185-612) min and 250 (123-440) min, respectively, and those for the da Vinci® Xi were 221 (150-430) min and 194 (93-337) min, respectively; values for the hinotori™ SRS were significantly higher. No significant differences were found in blood loss, length of hospital stay, or complications between the two groups. The longer operative times for the hinotori™ SRS were likely due to the learning curve associated with fewer cases.

Conclusion: Despite longer operative times, the hinotori™ SRS demonstrates surgical outcomes comparable to those of the da Vinci® Xi, indicating that RSC can be performed safely and effectively using the hinotori™ SRS. Future studies with larger sample sizes are needed to validate these findings.

Objectives: Laparoscopic surgery improves patient quality of life; however, its utility in stage IA1 cervical cancer remains debatable. This study aimed to compare the surgical and oncological outcomes of laparoscopic versus open surgery in patients with stage IA1 cervical cancer.

Materials and methods: Thirty-four patients, including 20 who underwent laparoscopic surgery and 14 who underwent open surgery, were enrolled in this study. The surgical and oncological outcomes were compared between the laparoscopic and open surgery groups.

Results: No statistically significant differences were observed between the laparoscopic and open surgery groups in terms of median age, body mass index, final pathological type, the presence of lymphovascular space invasion, and operation time. Patients who underwent laparoscopic surgery had significantly lower blood loss (38 vs. 170 mL, P < 0.001) and shorter postoperative hospital stay (5 vs. 7.5 days, P < 0.0001) than those who underwent open surgery. Oncological recurrence was observed in only one patient in the laparoscopic group (vaginal cuff). The 3-year recurrence-free survival rate was 94.7% and 100% for the laparoscopic and open surgery groups, respectively, with no statistically significant difference.

Conclusion: Laparoscopic surgery resulted in reduced blood loss and shorter hospital stay, with oncological outcomes comparable to those of open surgery in patients with stage IA1 cervical cancer. These findings highlight the potential benefits of laparoscopic surgery in improving surgical outcomes for patients with stage IA1 cervical cancer.

Objectives: Adolescents represent a significant demographic in hospital outpatient visits, and it is important to give them special consideration and conduct a thorough examination for any adnexal pathology. The research aimed to study adnexal masses in adolescent females aged 10-19 years, including their clinical, biochemical, and radiological evaluations. The goal was to develop a treatment plan and analyze its relationship with histopathological findings.

Materials and methods: The study was carried out at a single center and included 124 participants in a descriptive research design.

Results: During the study, 6.2% of adolescents had adnexal masses, with abdominal discomfort being the most common symptom (66.12%). Ultrasound scans showed cystic, solid, or complex masses in 41.6%, 23.4%, and 35% of cases, respectively. In 53.4% of the patients, tumors exceeding 10 cm in size were identified, while 66.67% exhibited elevated levels of tumor markers. Surgical procedures were necessary for 48.5% of adolescents, with laparoscopic cystectomy being carried out in 48.34% and staging laparotomy in 46.66%.

Conclusion: Small asymptomatic cysts need to be monitored, but larger complex or solid tumors must all be thoroughly examined to rule out malignancy. Early diagnosis and preservation of the ovary should be the aim of treatment. Although guidelines exist for the treatment of adnexal masses in adults, there is limited information available in the literature regarding adolescents. Therefore, it is crucial to establish an appropriate surgical plan that preserves fertility in this vulnerable age group.

We report a case of a pedunculated adenomyoma with osseous metaplasia, which mimics a dermoid cyst on magnetic resonance imaging (MRI) making it a considerable differential diagnosis. A 40-year-old female presented with chronic lower abdomen pain for a year. Pelvic MRI revealed a right-sided pelvic mass measuring 8.4 cm × 5.7 cm. The mass appeared isointense, with hyperintense contents similar to calcifications and fatty content. These results strongly indicated a dermoid cyst. During laparoscopy, a massive pedunculated uterine myoma was seen on the right posterior-fundal part of the uterus. During laparoscopic myomectomy, calcified tissues were discovered during manual morcellation. The histopathological examination confirmed the diagnosis of adenomyoma with widespread calcification and localized osseous metaplasia. Osseous metaplasia is an uncommon cytomorphological transformation seen mostly in the endometrium. Adenomyomas are rare, benign uterine tumors that are frequently misdiagnosed. In this case, the preoperative diagnosis suggested a dermoid cyst, broadening the differential diagnosis for calcified uterine tumors detected on MRI.

Cell death plays a pivotal role in a multitude of biological processes, including embryonic development, organ maintenance, aging, immune response, and autoimmunity. These processes are underpinned by distinct molecular mechanisms and have significant implications for biological systems. Currently, research on regulatory cell death (RCD) is primarily focused on apoptosis, necroptosis, pyroptosis, ferroptosis, cuproptosis, and autophagy. These pathways have been shown to play a crucial role in regulating the tumor microenvironment (TME) and influencing the clinical outcome of cancer immunotherapy. RCD exerts a dual regulatory effect on TME, releasing intracellular components and regulating the distribution of immune cells. These cells are involved in fine-tuning the antitumor immune response in the TME. The treatment of gynecological tumors frequently presents a challenge due to the lack of immunotherapeutic responsiveness. This review will focus on apoptosis, necroptosis, pyroptosis, ferroptosis, cuproptosis, and autophagy. It will explore how the molecular messengers released during these processes are involved in regulating their complex interactions with tumor tissues as well as with the immune response. It will also analyze the immunological consequences of regulated cell death and its potential impact on the future development of gynecological oncology therapy. By investigating the mechanisms of cell death, we can gain insight into their role in the development of gynecological tumors and potentially identify new therapeutic strategies to enhance the efficacy of existing treatments and advance cancer care.

Endometriosis, adenomyosis, and uterine adenomyomas prevail most frequently in reproductive-age women. However, about 2%-4% of postmenopausal women may suffer from endometriosis symptoms, while adenomyosis does not occur frequently after menopause in the absence of exogenous hormones. While cystic adenomyosis is an uncommon variant of adenomyosis, it is even rarer to be pedunculated. Usually, degeneration is a feature of uterine leiomyoma, 4% of which might be cystic, while ruptured adenomyoma with cystic degeneration is only reported few times in the literature. We present a case of a 50-year-old menopausal woman, with a ruptured pedunculated adenomyoma with endometriotic cystic degeneration, with a literature review.