A nationwide survey on gynecologic endoscopic surgery in Japan, 2014-2016.

AIM: Since 2014, Japan Society of Gynecologic and Obstetric Endoscopy and minimally invasive therapy (JSGOE) conducted a nationwide survey on gynecologic endoscopic surgery. We aimed to evaluate the current status and complications associated with endoscopic surgery by Japan gynecologic and obstetric endoscopy-database registry system (JOE-D). METHODS: Electrical medical records concerning the endoscopic surgery were generated from the daily use of reporting system. The subjects were all patients who underwent gynecologic endoscopic surgery. In addition to assessment of actual numbers, diagnosis, and operative methods, adverse events were registered. RESULTS: Total 203 970 patients performed laparoscopic, hysteroscopic and falloposcopic surgery for 3 years, 2014-2016. The numbers of endoscopic surgeries conducted in 2016 were increased more than 67 000, 13 000 or 450 cases, respectively. Incidence rates of complications involving these three types of surgeries in each year were approximately 3.1%. Incidences of intraoperative complications were relatively high in malignant diseases, laparoscopic-assisted vaginal hysterectomy (LAVH) and myomectomy (LAM). In total laparoscopic hysterectomy/laparoscopic hysterectomy (TLH/LH) performed from 2014 to 2016, ureteral injury as intra and postoperative complication occurred in 0.35%. In the past 3 years, the rates of vascular injury, urinary tract, and bowel injury as intraoperative complications caused by laparoscopic surgery were approximately 0.1%. In the hysteroscopic surgery, the rates of total intra- and postoperative complications were 0.78%. CONCLUSION: We exhibited the current status by the nationwide survey of gynecologic endoscopic surgery all over Japan. Severe intra or postoperative complications were identified over the 3 years at a rate of 0.04%.

Pathological evaluation of the rat endometriosis model.

OBJECTIVE: To observe in detail the morphology of experimental rat endometriosis, specifically in peritoneum adjacent to uterine transplants attached via autotransplantation. DESIGN: Light and electron microscopic study. SETTING: Tochigi Institute of Clinical Pathology, Japan. ANIMAL(S): Female-SD rats maintained on a schedule of 12 hours of light and 12 hours of dark for 2 weeks. INTERVENTION(S): Uterine transplants were attached to rat peritoneum via the surgical autotransplantation technique. The implanted area of peritoneum, including abdominal muscle, were excised from anesthetized rats at four (n = 10), seven (n = 10), and 14 (n = 10) days after uterine autotransplantation. The mesenteries were autotransplanted as a comparative control. MAIN OUTCOME MEASURE(S): We examined the morphologic alterations of uterus-attached peritoneum following the time interval after the implantation. RESULT(S): In rat endometriosis models, the stromal tissue of uterus-attached peritoneum showed proliferation and infiltration of mast cells, eosinophils, plasma cells, lymphocytes, and macrophages. These lesions increased with time after implantation; however, ultimately these infiltrating cells disappeared and proliferation declined. CONCLUSION(S): Our findings suggest that uterine autotransplantation induces the infiltration of allergic inflammatory-related cells and proliferative lesions in peritoneal stroma attached endometrium. These data should prove useful for investigations of human endometriosis.

Light and electron microscopic evaluation of antileukotriene therapy for experimental rat endometriosis.

OBJECTIVE: To evaluate the effect of antileukotriene therapy, we examined the morphologic alteration in experimental rat endometriosis both with and without leukotriene receptor antagonist treatment. DESIGN: Light and electron microscopic analysis. SETTING: Tochigi Institute of Clinical Pathology, Japan. ANIMAL(S): Female Sprague-Dawley rats maintained on a schedule of 12 hours of light and 12 hours of dark for 2 weeks. INTERVENTION(S): Uterine transplants were attached to rat peritoneum via the surgical autotransplantation technique. After autotransplantation, the rats were given daily administration of leukotriene receptor antagonist, and the lesions were examined at 4 and 7 days after autotransplantation. MAIN OUTCOME MEASURE(S): The morphologic comparison of rat endometriosis with and without antileukotriene therapy. RESULT(S): In the rats treated with leukotriene receptor antagonist, a significant decrease in stromal proliferation was observed when compared with nontreated rats. The treated rats showed not only the suppression of infiltration and activation of mast cells but also widespread apoptosis of proliferative fibroblasts in the lesions. CONCLUSION(S): Our results reveal that a leukotriene receptor antagonist has significant therapeutic value for the treatment of rat endometriosis. It is likely that antileukotriene therapy would be efficacious in the treatment and prevention of human endometriosis.

Role of immunoreactions and mast cells in pathogenesis of human endometriosis--morphologic study and gene expression analysis.

STUDY OBJECTIVES: To investigate the pathophysiology of human endometriosis, we examined by morphological and molecular biological methods. METHODS: Samples of ovarian endometriosis and normal ovarian tissues were obtained laparoscopically after informed consent. A morphological study by toluidine blue staining, immunohistochemistry of c-kit and electron microscopy demonstrated the localization of mast cells in the stromal lesions of endometriosis. Oligonucleotide microarrays were used for gene expression analysis. RESULTS: Infiltration of numerous mast cells and development of fibrosis was observed throughout the stromal lesions. Gene expression analysis by oligonucleotide microarrays indicated inflammatory immunoreactions in the lesions. Expressions of the FCER1G and PGDS, which are considered to be mast cell-specific genes, were upregulated in the ovarian endometriotic lesions as compared to the normal ovarian tissues. Furthermore, expressions of genes associated with immunological inflammation, such as IL-8, GRO1, GRO2, CXCR4, MCP1, and those related to tissue remodeling (MMP, COL4A2, and COL5A2) were also higher in endometriotic lesions than in the normal ovarian tissue. CONCLUSIONS: Thus it is likely that mast cells and their related inflammatory immunoreactions via chemokines play important roles in producing fibrosis and adhesions in endometriotic lesions.

Surgery results using different uterine wall incision directions in laparoscopic myomectomy of the intramural myoma.

Objective: To study clinical outcomes for different uterine wall incision directions, comparing vertical incision and transverse incision in laparoscopic myomectomy of the intramural myoma. Methods: Laparoscopic myomectomies were performed on 50 women with intramural myomas. Using a table of random numbers, they were randomly divided into a vertical incision group (25 women) and a transverse incision group (25 women) according to the direction of incisions in the uterine wall. The numbers of enucleated myoma, operation duration, amount of bleeding, and numbers of sutures were compared. The Mann-Whitney U-test was used for analysis. Results: For the transverse incision group, the amount of bleeding (137.6 ± 88.1 mL) was a significantly lower value (P = 0.0426) than for the vertical incision group (235.8 ± 169.4 mL). In addition, in cases where the maximum myoma nucleus diameter was 7 cm or larger, operation duration (129.0 ± 32.5 min) and amount of bleeding (158.9 ± 87.1 mL) showed significantly lower values (P = 0.0067 and P = 0.0002, respectively) for the transverse incision group than did operation duration (362.3 ± 147.3 min) and amount of bleeding (362.3 ± 147.3 mL) for the vertical incision group. Conclusion: Transverse incision of the uterine wall is useful to reduce the amount of bleeding in the laparoscopic myomectomy of the intramural myoma. Transverse incision also shortens operation duration in cases where the myoma nuclei are large. (Reprod Med Biol 2004; 3: 33-37).

Increase of activated mast cells in human endometriosis.

PROBLEM: The proliferation of stromal cells in endometriosis promotes extensive adhesion; therefore, the morphological analysis of stromal lesions is important in the investigation of the pathogenesis of endometriosis. METHOD OF STUDY: In this study, the morphological and numeric comparisons of degranulated mast cells were performed between endometriotic lesions and comparative regions (eutopic endometrium and normal uterine serosa) of patients with and without endometriosis. RESULTS: In cases of endometriosis, diffuse infiltration of numerous mast cells was observed throughout the stromal lesions. These mast cells exhibited degranulation, and scattered granules were also observed. In the eutopic endometrium and normal uterine serosa of both the endometriosis patients and the controls, mast cells were rarely detected. CONCLUSIONS: These results suggest that an abnormal immune response, specifically a hypersensitivity reaction, is strongly related to endometriosis; our findings will be helpful in the development of methods for the treatment of endometriosis.