Objective: The purpose of this study was to evaluate a new tissue model and to conduct a questionnaire survey to assess its feasibility for robot-assisted radical hysterectomy, colpotomy, and pelvic lymph node dissection training. Methods: Sixteen gynecologists (12 males, 4 females; mean age: 47.1 years; all attending doctors with an average experience of 9.3 robot-assisted surgeries) were trained in robot-assisted radical hysterectomy, colpotomy, and pelvic lymphadenectomy using a new uterine and pelvic lymph node model (mainly composed of PVA) from Fasotec Inc. The participants were trained by the author using a dual console. They performed all surgical procedures following the author's instructions. The time required for completion of the surgeries was measured. The surgical skills of the participants were evaluated by the author using the operative performance rating scale recommended by the American College of Surgeons. After training, the participants answered a questionnaire for the assessment of the model and the training using a 5-point Likert scale. Results: We found that the mean time taken for radical hysterectomy, colpotomy, and pelvic lymphadenectomy was 57.3 minutes (range: 45–75 minutes), 12.2 minutes (range: 8–17 minutes), and 60.7 minutes (range: 45–70 minutes), respectively; the total time taken was 136.5 minutes (range: 98–162 minutes). The questionnaire survey revealed that this model followed pelvic anatomy and was practically trainable. Conclusion: This is the first report of a tissue model relevant to the uterus and the pelvic lymph nodes, and robot-assisted training using this model was considered effective.
Bowel endometriosis sometimes causes repeated intestinal obstruction during menstruation. Recently, there are an increasing number of cases of bowel endometriosis treated with laparoscopic bowel resection. We had a case of ileal endometriosis with recurrence of intestinal obstruction during menstruation. A 34 year-old woman was referred with a left ovarian endometrioma 4 cm in diameter. She had just recovered from conservative treatment of intestinal obstruction, which had developed during menstruation. We planned a laparoscopic cystectomy of her left ovarian endometrioma. She relapsed with intestinal obstruction during menstruation, which was again treated conservatively. Computed tomography at the onset of intestinal obstruction showed stenosis of the distal ileum. Ileal endometriosis was suspected as the cause of this stenosis. Her next menstrual period was estimated to overlap with the planned laparoscopic operation. Another recurrence of intestinal obstruction during her next menstruation could necessitate a delay in the operation, or a conversion to laparotomy. She was treated with dienogest for prevention of intestinal obstruction recurrence for one month before the operation. Concurrent laparoscopic resection of the left ovarian endometrioma and ileal endometriosis was performed as scheduled without recurrence of intestinal obstruction. Pathological examination confirmed ileal endometriosis and left ovarian endometrioma. No recurrence of either ovarian endometrioma or intestinal obstruction has been detected for one year after the operation. Our experience suggests that it would be better to avoid planning laparoscopic surgery during menstruation in suspected bowel endometriosis, or to start drug treatment to prevent endometriosis-associated bowel obstruction.
Poly (ADP-ribose) polymerase inhibitors have been increasingly used in ovarian cancer treatment. However, the real-world safety data of these drugs in Japanese patients are limited. This retrospective study included 181 patients with ovarian cancer who received olaparib or niraparib at two independent hospitals in Japan between May 2018 and December 2022. Clinical information and blood sampling data were collected. Regarding patient backgrounds, the olaparib group had higher proportions of patients with serous carcinoma, BRCA positivity, homologous recombination deficiency, and those receiving maintenance therapy after recurrence treatment than the niraparib group. Regarding toxicity properties, the most common reasons for discontinuation in the olaparib group were anemia, fatigue, and nausea, while the reason in the niraparib was thrombocytopenia. Thrombocytopenia caused by niraparib treatment occurred earlier than anemia caused by olaparib treatment. Patients with a low body mass index or who had undergone several previous treatment regimens were more likely to discontinue treatment within the first 3 months. Although we analyzed blood collection data, predicting treatment interruptions due to blood toxicity was challenging. In this study, we revealed the characteristics of patients and the timing of interruptions for each drug, highlighting the importance of carefully managing adverse effects.
Objective: Traditionally, laparotomy has been the main surgical treatment in gynecologic oncology. However, the recent development of various devices and the results of randomized controlled studies have enabled the introduction of total laparoscopic hysterectomy for early-stage endometrial cancer. The aim of this single-center study was to compare laparotomy and laparoscopy for endometrial cancer.
Objective: This study was conducted to analyze whether preoperative magnetic resonance imaging (MRI) can be used as a predictor of difficult total laparoscopic hysterectomy.
Abstract Background Poly (ADP-ribose) polymerase (PARP) inhibitors, such as olaparib and niraparib, have been increasingly used in ovarian cancer treatment. However, the real-world safety data of these drugs in Japanese patients and the predictability of treatment interruptions are limited. Methods This retrospective study included 181 patients with ovarian cancer who received olaparib or niraparib at two independent hospitals in Japan between May 2018 and December 2022. Clinical information and blood sampling data were collected. Patient characteristics, treatment history, and hematological data trends were compared, and the predictability of treatment interruptions based on blood sampling data was examined. Results Regarding patient backgrounds, the olaparib group had higher proportions of patients with serous carcinoma, BRCA positivity, homologous recombination deficiency, and those receiving maintenance therapy after recurrence treatment than the niraparib group. Regarding toxicity properties, the most common reasons for discontinuation in the olaparib group were anemia, fatigue, and nausea, while discontinuation was primarily due to thrombocytopenia in the niraparib group. Thrombocytopenia caused by niraparib treatment occurred earlier than anemia caused by olaparib treatment. Patients with a low body mass index or who had undergone several previous treatment regimens were more likely to discontinue treatment due to adverse effects within the first 3 months. Although we analyzed blood collection data, predicting treatment interruptions due to blood toxicity using blood data was challenging. Conclusions In this study, we revealed the characteristics of patients and the timing of interruptions for each drug, highlighting the importance of carefully managing adverse effects, particularly during the early treatment stages.
Objective: Radical hysterectomy with pelvic lymphadenectomy is standard therapy for cervical cancer. The standard surgical lymph node assessment is a systematic lymphadenectomy, but the procedure is associated with lymphedema and lymphocysts. A sentinel lymph node (SLN) is the first node draining the lymphatic flow from a primary tumor. If the SLN is negative for metastasis, nodes after the SLN are also considered to be negative. We report our experience using a new laparoscopic fluorescence imaging system with indocyanine green (ICG) for SLN detection with cervical cancer.Methods: Participants included 12 patients treated from April 2014 to April 2015. Median age was 41.8 years (range, 27-56years) and median body mass index was 20.2 kg/m2 (range, 15-31 years). Patients underwent SLN mapping by intracervical injection of ICG at 3 and 9 o'clock positions. Following SLN mapping, radical hysterectomy and pelvic lymphadenectomy was performed. Result: Median SLN count was 2.8 (range, 1-7). The overall and bilateral detection rate was 100% (12/12) and 83% (10/12), respectively. Positive SLNs were identified in 2 of 12 patients (16%). SLNs were identifided in the external iliac, internal iliac, obturator and common iliac regions and sensitivity, specificity and NPV were all 100%. Conclusions: Fluorescence imaging using ICG is a feasible and safe method for SLN detection. In the future, this technique may represent a useful treatment for patients with early cervical cancer.
Abstract Background Poly (ADP‐ribose) polymerase (PARP) inhibitors have been increasingly used in the treatment of ovarian cancer, with BRCA positivity and homologous recombination deficiency (HRD) being common biomarkers used for predicting their efficacy. However, given the limitations of these biomarkers, new ones need to be explored. Methods This retrospective study included 181 ovarian cancer patients who received olaparib or niraparib at two independent hospitals in Japan between May 2018 and December 2022. Clinical information and blood sampling data were collected. Patient characteristics, treatment history, and predictability of treatment duration based on blood data before treatment initiation were examined. Results High‐grade serous carcinoma, BRCA positivity, HRD, and maintenance therapy after recurrence treatment were observed more frequently in the olaparib group than in the niraparib group. The most common reasons for treatment interruption were anemia, fatigue, and nausea in the olaparib group and thrombocytopenia in the niraparib group. Regarding response to olaparib treatment, complete response to the most recent treatment, maintenance therapy after the first chemotherapy, high‐grade serous carcinoma, and germline BRCA positivity were observed significantly more frequently among responders than among non‐responders. Furthermore, neutrophil counts were significantly higher among responders than among non‐responders. Conclusions Inflammation‐related blood data, such as neutrophil count, obtained at the initial pre‐treatment visit might serve as potential predictors for prolonged olaparib treatment. While this study offers valuable insights into potential indicators for prolonged olaparib treatment, it underscores the need for more expansive research to strengthen our understanding of PARP inhibitors and optimize treatment strategies in ovarian cancer.
