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.
Alumina ceramics have excellent mechanical and biocompatible properties, but are bioinert and hence have no bone-bonding properties. We took a tissue engineering approach in an attempt to modify the ceramic surface and so provide an osteogenic/osteoconductive milieu. We used fresh human bone marrow cells obtained from the iliac crest by needle aspiration for culture expansion of mesenchymal stem cells (MSC) followed by in vitro osteogenic differentiation on both tissue culture polystyrene (TCPS) and alumina ceramics. We have succeeded in expanding the number of MSC from all 35 cases and compared the differentiation capability of selected MSC on alumina ceramics to that on TCPS. The cells on both substrata showed extensive alkaline phosphatase staining and mineralization as evidenced by calcein uptake. Biochemical analyses revealed high levels of alkaline phosphatase activity, osteocalcin expression, and calcium content. These data indicate that an alumina ceramic surface can support a differentiation cascade of MSC resulting in osteoblastic phenotype expression of the cells. Based on these results, we have performed clinical applications of tissue engineered total joint replacements for osteoarthritic patients.
We report a patient with recurrent refractory small cell carcinoma of the uterine cervix, in whom combined therapy with paclitaxel, cisplatin, and bevacizumab (TP+Bev) was effective. Small cell cervical carcinoma is a rare malignancy and its outcome is reported to be poor. The patient was a 45-year-old woman who visited a local hospital with the chief complaint of irregular vaginal bleeding and was referred to our department. The results of a smear test and examination of a tissue biopsy specimen suggested small cell carcinoma. FIGO stage II A disease was diagnosed by MRI and CT. She underwent radical hysterectomy with bilateral adnexectomy, and pelvic and para-aortic lymph node dissection. Although postoperative adjuvant chemotherapy was performed, local recurrence was found at three years after surgery. She received radiation therapy to the whole pelvis, bilateral inguinal regions, and site of recurrence. However, multiple liver metastases were detected and the tumor was considered to be refractory. Subsequently, she received TP+Bev as systemic chemotherapy, after which the local recurrence disappeared and the liver metastases became smaller.
This study aimed to examine an association between intrauterine manipulator (IUM) use and frequency of lymphovascular space invasion (LVSI) in women with endometrial cancer undergoing minimally invasive hysterectomy.A retrospective case-control study was conducted among stage I-IV endometrial cancer patients who underwent hysterectomy between 2008 and 2015. Medical records were reviewed for patient demographics, surgical details, and tumor characteristics. Women who underwent total laparoscopic hysterectomy (TLH) with IUM use were compared with women who underwent total abdominal hysterectomy (TAH). Review of archived medical record for data collection and propensity score matching were performed to adjust for background differences between TLH-IUM and TAH groups. A systematic literature review with pooled analysis was performed to examine frequency of LVSI.There were 687 women who underwent hysterectomy for endometrial cancer. Of those, 419 women underwent TLH with IUM use and 194 women underwent TAH. The most common type of IUM was VCare (89.5%). There was no statistically significant difference in the frequency of LVSI between the 2 groups: 15.1% for TLH-IUM vs 19.9% for TAH (P = 0.14). After propensity score matching, frequencies of LVSI were similar between the 2 groups: 21.2% for TLH-IUM vs 19.6% for TAH (P = 0.78). Systematic literature review identified 1371 cases of TLH-IUM and 1246 cases of TAH performed for endometrial cancer, and frequencies of LVSI were similar between the 2 groups (15.0% vs 13.6%, P = 0.31).Our study suggests that IUM use during TLH for endometrial cancer is not associated with increased frequency of LVSI.
Human marrow mesenchymal stem cells were cultured in a medium containing glycerophosphate, ascorbic acid, and dexamethasone (Dex) on alumina ceramic discs and on tissue culture polystyrene (TCPS) dishes. Cell proliferation followed by osteogenic differentiation was observed to be equal on both culture substrata. The differentiation resulted in the appearance of bone-forming osteoblasts, which fabricated mineralized matrices on these substrata. Stem cells kept at 4 degrees C for 24 h outside a CO2 incubator maintained a viability level of more than 90%. The regenerative cultured bone outside the incubator also maintained high alkaline phosphatase activity for several hours. These results verified that cultured bone fabricated at a cell processing center can be transported to distant hospitals for use in hard tissue repair. To date, the tissue engineered cultured bone formed on alumina ceramics in this environment have already been used in clinical situations, such as total ceramic ankle replacements.
