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Background and Objectives: The aim of this prospective study was to evaluate the diagnostic accuracy of the one-step nucleic acid amplification (OSNA) assay for the intraoperative assessment of sentinel lymph node (SN) metastases, including micrometastases in patients with stage IA low-grade endometrial cancer. Materials and Methods: A prospective analysis was conducted on 204 patients with low-risk endometrial cancer who underwent hysterectomy, bilateral salpingo-oophorectomy, and sentinel node navigation surgery. SNs were analyzed intraoperatively using the OSNA assay, and positive patients underwent systematic pelvic lymphadenectomy. Results: Among the 204 patients included, SN metastases were identified in 12 patients (6%), including 10 patients with micrometastases and 2 patients with macrometastases. No metastases were detected in non-SNs in any of the 12 patients. Recurrence occurred in two patients (1%), involving the vaginal stump and pelvic cavity dissemination, but no lymph node recurrence was observed. The OSNA assay identified a proportion of micrometastases in low-risk endometrial cancer. While a direct comparison with conventional pathological ultra-staging was not performed in this study, the detection rate of micrometastases appears higher than that reported in historical controls. Conclusions: This is the first prospective study to evaluate the intraoperative use of the OSNA assay for whole SNs in endometrial cancer. The results suggest that the OSNA assay enhances the detection of micrometastases, enabling a more accurate assessment of SN metastases. In low-risk endometrial cancer, systematic pelvic lymphadenectomy may be safely omitted in patients with SN-positive micrometastases. Further prospective studies are necessary to validate these findings and support the adoption of this approach in clinical practice.
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Neoplasias do Endométrio , Técnicas de Amplificação de Ácido Nucleico , Linfonodo Sentinela , Humanos , Feminino , Neoplasias do Endométrio/cirurgia , Neoplasias do Endométrio/patologia , Neoplasias do Endométrio/diagnóstico , Estudos Prospectivos , Técnicas de Amplificação de Ácido Nucleico/métodos , Pessoa de Meia-Idade , Linfonodo Sentinela/patologia , Idoso , Metástase Linfática/diagnóstico , Biópsia de Linfonodo Sentinela/métodos , Adulto , Idoso de 80 Anos ou mais , Micrometástase de Neoplasia/diagnóstico , Excisão de Linfonodo , Período Intraoperatório , Cuidados Intraoperatórios/métodosRESUMO
Background and Objectives: To evaluate the feasibility and clinical outcomes of a novel non-mesh robot-assisted sacrocolpopexy (RSC) using autologous round ligament (ARL) grafts in patients with pelvic organ prolapse (POP). Materials and Methods: This retrospective study included 92 patients who underwent non-mesh RSC with ARL grafts at Kagoshima University Hospital between August 2020 and June 2024. All patients met the inclusion criteria for symptomatic POP-Q stage II or higher and elected to undergo non-mesh RSC. The procedures were performed using the da Vinci® Xi or the hinotori™ Surgical Robot System. The clinical characteristics, operative data, complications, and recurrence rates were analyzed. Results: ARL harvesting was feasible in all patients, and the non-mesh RSC procedure was completed without conversion to open surgery or any intraoperative complications. The median operative time was 251 min, and the median blood loss was 30 mL. Postoperative complications of Clavien-Dindo grade ≥ 2 occurred in five patients (5%), all of whom developed pelvic infections. De novo stress urinary incontinence was observed in one patient (1%). POP recurrence occurred in seven patients (8%) during a median follow-up of 3 months (range, 3-18 months), all of whom presented with cystocele. Five patients underwent reoperation, and two were managed conservatively. All patients experienced postoperative symptomatic improvement. A higher BMI and advanced POP-Q stage were significant predictors of recurrence. Conclusions: This is the first report of non-mesh RSC using an ARL graft. The procedure is feasible and effective, avoids the use of synthetic mesh, and offers short-term outcomes comparable to those of mesh-based RSC. ARL-based RSC represents a promising alternative, especially for patients at risk of mesh-related complications. Long-term follow-up is required to confirm durability.
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Procedimentos Cirúrgicos em Ginecologia , Ligamentos , Prolapso de Órgão Pélvico , Procedimentos Cirúrgicos Robóticos , Humanos , Feminino , Estudos Retrospectivos , Prolapso de Órgão Pélvico/cirurgia , Pessoa de Meia-Idade , Idoso , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Robóticos/normas , Estudos de Viabilidade , Resultado do Tratamento , Ligamentos/transplante , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos em Ginecologia/métodos , Duração da CirurgiaRESUMO
Robot-assisted surgery has become widely accepted as a minimally invasive approach. However, its safety and feasibility in older women undergoing gynecologic procedures remain insufficiently explored. This retrospective study compared perioperative outcomes between two older age groups and evaluated surgical risks by using the E-PASS and POSSUM scoring systems. A total of 61 women aged ≥ 70 years who underwent robot-assisted gynecologic surgery at our institution were analyzed. Endometrial cancer cases involved hysterectomy with sentinel lymph node biopsy, while procedures for pelvic organ prolapse included sacrocolpopexy with vaginal surgery. The patients were categorized into pre-old (70-74 years) and old (75-89 years) groups. Although prior abdominal surgery was significantly more common in the old group (58.3 vs. 13.5%, p = 0.0003), no significant differences were found in comorbidities, the operative time (242 vs. 235 min), blood loss, or the duration of hospital stay. One pre-old patient developed a pelvic infection (Clavien-Dindo grade IIIa); no other serious complications occurred, and overall complication rates were similar. Two cases of postoperative delirium were not predicted preoperatively. Perioperative risk scores indicated a low risk in both groups. While midterm postoperative outcomes were generally favorable, some patients experienced new health-related events, which were unrelated to surgery. These findings suggest that robotic surgery is feasible and that age alone should not be a contraindication. However, importantly, these outcomes were achieved in a cohort that received comprehensive perioperative care; therefore, further studies with larger cohorts are needed. Moreover, perioperative planning should consider not only physical conditions but also the cognitive and mental status, the living environment, and social support.
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Procedimentos Cirúrgicos em Ginecologia , Procedimentos Cirúrgicos Robóticos , Humanos , Feminino , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Idoso , Estudos Retrospectivos , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos em Ginecologia/métodos , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Medição de Risco , Complicações Pós-Operatórias/epidemiologia , Prolapso de Órgão Pélvico/cirurgia , Resultado do Tratamento , Neoplasias do Endométrio/cirurgia , Fatores Etários , Duração da Cirurgia , Tempo de InternaçãoRESUMO
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.
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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.
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OBJECTIVE: To identify clinical and pathological factors associated with unsuccessful bilateral sentinel lymph node (SLN) detection using the technetium-99m-labeled phytate radiocolloid method (RI method) in patients with endometrial cancer. METHODS: This prospective observational study included 223 patients with histologically confirmed presumed early-stage endometrial cancer who underwent SLN mapping between July 2018 and May 2022 at Kagoshima University Hospital. A radiocolloid tracer was injected into the cervix the day before surgery, followed by preoperative single-photon emission computed tomography combined with computed tomography imaging. The SLNs were intraoperatively localized using a gamma probe and assessed via frozen sections or one-step nucleic acid amplification. Bilateral SLN detection was defined as successful localization of at least one SLN in each hemipelvis. Multivariate logistic regression was used to identify the independent predictors of detection failure. RESULTS: The overall bilateral SLN detection rate was 83.4% (186/223). In the univariate analysis, advanced age (median 63.0 vs. 58.0 years, p = 0.0003) and myometrial invasion ≥50% (p = 0.0289) were associated with unsuccessful detection. In the multivariate analysis, age was a significant independent predictor (OR = 1.057, 95% CI: 1.017-1.099, p = 0.0037), whereas other variables, including body mass index, histological type, lymphovascular space invasion, and cervical stromal invasion, were not. CONCLUSIONS: Advanced age significantly increased the risk of unsuccessful bilateral SLN detection using the RI method for endometrial cancer. These findings emphasize the need for individualized surgical planning in older patients, including preoperative counseling and consideration of adjunctive strategies to improve detection rates, particularly in cases in which alternative tracers, such as indocyanine green, are not reimbursed.
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OBJECTIVE: This report presents a rare case involving an extreme epithelial-to-mesenchymal transition, in which a specific type of sarcoma developed heterochronically as a recurrence of endometrioid carcinoma. CASE PRESENTATION: A female in her 50's presented with abnormal genital bleeding, and an endometrial biopsy revealed endometrioid carcinoma. Following the diagnosis of stage IA endometrioid carcinoma according to the 2008 classification system of the International Federation of Gynecology and Obstetrics, a robot-assisted simple hysterectomy, bilateral salpingo-oophorectomy, and sentinel lymph node navigation surgery were performed. Six months postoperatively, a tumor mass developed in the pelvis. A transrectal needle biopsy revealed spindle cell proliferation, and pelvic tumor resection was conducted for diagnostic therapy. The patient received no adjuvant chemotherapy or radiotherapy after the second surgery and remained free of tumor recurrence for 8 months. The resected yellowish solid tumor mass, measuring 16 × 12 × 9 cm, exhibited hemorrhage, necrosis, and cystic degeneration and was composed of fascicular proliferation of spindle tumor cells showing nuclear pleomorphism and frequent mitotic figures within a myxoid and inflammatory stroma. No epithelial component or organoid patterns were observed. Immunohistochemically, the tumor cells were positive for factor XIIIa, CD10, and cyclin D1, but negative for keratins (AE1/AE3 and CAM5.2) and other specific markers, supporting a diagnosis of high-grade myxoinflammatory fibroblastic sarcoma (MIFS). CONCLUSION: Genomic analysis revealed identical mutations in PTEN, PIK3R1, CDKN2 A, and TP53 in both the primary uterine endometrioid carcinoma and heterochronic pelvic MIFS. An integrative approach involving histology, immunohistochemistry, and genomic analysis is critical for elucidating the pathogenesis of rare pelvic and uterine tumors.
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Carcinoma Endometrioide , Neoplasias do Endométrio , Sarcoma , Neoplasias Uterinas , Humanos , Feminino , Pessoa de Meia-Idade , Mutação , Carcinoma Endometrioide/patologia , Carcinoma Endometrioide/genética , Carcinoma Endometrioide/cirurgia , Neoplasias Uterinas/patologia , Neoplasias Uterinas/genética , Neoplasias do Endométrio/patologia , Neoplasias do Endométrio/genética , Neoplasias do Endométrio/cirurgia , Biomarcadores Tumorais/genética , Sarcoma/patologia , Sarcoma/genética , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/genéticaRESUMO
The effectiveness of cystoscopy in reducing urinary tract complications during robotic gynecologic surgery is poorly documented. Since the introduction of robotic surgery at our institution, cystoscopy has been consistently employed as a standard practice, and its usefulness was investigated. This retrospective study evaluated the utility of routine cystoscopy in patients who underwent robotic surgery between February 2017 and April 2024. The outcome was the detection rate of bladder and ureteral complications. Indigo carmine was injected intravenously while suturing the post-hysterectomy vaginal stump. Light permeation of the bladder wall was visually assessed intra-abdominally. Any leakage of the indigo carmine into the peritoneum or outflow from the external ureteral opening were noted. Eleven of 403 patients were suspected of having urinary tract complications. Among the 11 patients, two exhibited damage to the serous and muscular layers of the bladder, while nine had no outflow from the external ureteral opening. Among these nine cases, one patient was found to have right ureteral obstruction, which was attributed to vaginal stump suturing. The sensitivity and specificity for ureteral obstruction detection were 100% and 98.0%, respectively. In the remaining eight patients, no urinary complications could be identified postoperatively. Overall, the rate of bladder injury was 4/403 (0.9%), all of which were repaired intraoperatively, including two cases found by cystoscopy. Ureteral obstruction was identified in 1/403 (0.2%), and the case was due to intraoperative cystoscopy. Postoperatively, ureteral stenosis was observed in 1/403 (0.2%), and urinary tract infection (cystitis: Grade 2 or less) was noted in 6/403 (1.5%). This technique is an effective diagnostic tool with minimal patient burden and is likely to accurately identify ureteral obstruction or bladder injury during surgery.
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Cistoscopia , Histerectomia , Complicações Intraoperatórias , Procedimentos Cirúrgicos Robóticos , Humanos , Feminino , Cistoscopia/métodos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/métodos , Histerectomia/métodos , Histerectomia/efeitos adversos , Estudos Retrospectivos , Pessoa de Meia-Idade , Adulto , Complicações Intraoperatórias/diagnóstico , Bexiga Urinária/lesões , Idoso , Complicações Pós-Operatórias/prevenção & controle , Obstrução Ureteral/etiologia , Obstrução Ureteral/diagnóstico , Cuidados Intraoperatórios/métodosRESUMO
BACKGROUND: The incidence of endometrial cancer in Japan has more than doubled over the past 2 decades because of increasing obesity rates and the unique physiological traits of Asian populations. The aim of this retrospective study was to examine the impact of obesity on surgical outcomes, prognosis, and costs. METHODS: A total of 197 patients with stage IA endometrial cancer who underwent robot-assisted hysterectomy, bilateral salpingo-oophorectomy, and lymphadenectomy/biopsy from 2018 onward were included. Patients were divided into the BMI < 30 kg/m2 group (n = 117) and the BMI ≥ 30 kg/m2 group (n = 80). The clinical and pathological factors, surgical outcomes, perioperative complications, and treatment costs were compared. The median follow-up period was 34.9 months (range: 6.1-84.2). RESULTS: In the BMI ≥ 30 kg/m2 group, significant differences in comorbidities, including diabetes mellitus (19.7% vs. 51.3%), hypertension (43.6% vs. 58.8%), and hyperlipidemia (29.9% vs. 50%), were detected. However, no significant differences were found in operative time, blood loss volume, perioperative complication rates, or 5-year cancer-specific survival rates (97.6% vs. 100%). Surgical and hospitalization costs were higher in the BMI ≥ 30 kg/m2 group, indicating a financial burden for both patients and healthcare facilities. Additionally, a higher prevalence of newly developed lifestyle-related diseases, such as cardiovascular diseases and diabetes, was observed during the follow-up (2.5% vs. 10%). CONCLUSIONS: While obesity (BMI ≥ 30) did not significantly impact surgical outcomes or cancer prognoses, it did increase treatment costs and the risk of lifestyle-related diseases. Thus, preventive strategies, including lifestyle counseling, are needed to reduce obesity-related health burdens.
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Neoplasias do Endométrio , Obesidade , Procedimentos Cirúrgicos Robóticos , Humanos , Feminino , Obesidade/complicações , Obesidade/economia , Obesidade/epidemiologia , Neoplasias do Endométrio/cirurgia , Neoplasias do Endométrio/patologia , Neoplasias do Endométrio/economia , Neoplasias do Endométrio/complicações , Procedimentos Cirúrgicos Robóticos/economia , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Pessoa de Meia-Idade , Idoso , Japão/epidemiologia , Estudos Retrospectivos , Histerectomia/economia , Histerectomia/métodos , Estadiamento de Neoplasias , Excisão de Linfonodo/economia , Excisão de Linfonodo/métodos , Resultado do Tratamento , Índice de Massa Corporal , Idoso de 80 Anos ou mais , Adulto , Complicações Pós-Operatórias/epidemiologia , Prognóstico , Salpingo-Ooforectomia/economia , Salpingo-Ooforectomia/métodosRESUMO
Introduction Vaginal cuff dehiscence (VCD) is a rare but serious complication following hysterectomy, with a higher incidence in minimally invasive surgery (MIS). The choice of suture material and closure technique may influence the risk of VCD. Barbed sutures, such as STRATAFIX™ Spiral PDS Plus, enhance tissue approximation and eliminate the need for knot tying, potentially improving wound healing. This study aimed to evaluate the incidence of VCD following robot-assisted total hysterectomy (RAH) with vaginal cuff closure using barbed sutures. Methods This retrospective cohort study included patients who underwent RAH at Kagoshima University Hospital between July 2017 and July 2024. Patients who had vaginal cuff closure with barbed sutures were analyzed, while those who underwent supracervical hysterectomy or had vaginal cuff closure with non-barbed sutures were excluded. VCD was assessed through pelvic examinations at one, three, and six months postoperatively, or earlier if clinically indicated. The presence or absence of VCD was determined based on findings within six months after surgery. All procedures were performed by certified gynecologic oncologists and laparoscopic surgeons using either the da Vinci® Xi or hinotori™ Surgical Robot System. Colpotomy was performed using monopolar coagulation (35 W), followed by vaginal cuff closure with interrupted 0-Polyglactin 910 sutures at the lateral ends and continuous barbed suture closure. Results A total of 313 patients were included, with a median age of 55 years and a median BMI of 28 kg/m². Of these, 270 (86%) had malignant conditions, while 43 (14%) had benign conditions. The median operative time was 201 minutes, and the median blood loss was 20 mL. Retroperitoneal suturing was performed in 224 patients (72%). No cases of VCD were observed. Conclusions This study demonstrates that vaginal cuff closure using barbed sutures during RAH is a feasible and safe technique, with no instances of VCD reported within the six-month postoperative period. The standardized surgical approach contributed to consistent outcomes across the cohort. These findings suggest that barbed suture closure may effectively reduce the risk of VCD, particularly in high-volume robotic surgery settings.
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OBJECTIVE: This study evaluates clinicopathological outcomes and clinicians' awareness regarding the management of atypical glandular cells (AGC). METHODS: We analyzed 98 AGC cases, excluding known endometrial cancer, from 238 initial cases, with a median age of 42 years (range 20-82). Cytological findings, including NOS and FN subcategories, diagnostic tests, treatments, and outcomes were evaluated. A survey on AGC awareness and practices was conducted among 134 obstetrician-gynecologists. RESULTS: Of 98 cases (AGC-FN: 19.8%, AGC-NOS: 13.2%, unspecified: 67.3%), 44.9% initially showed no neoplasia; this dropped to 38.8% following up, identifying 11 additional AIS or cervical adenocarcinomas. Overall, 28.5% had AIS or more, 18% had CIN, and 13.3% had other malignancies, indicating some over/underdiagnosis. HPV testing in 79 cases showed a 48.1% positivity rate, including 14 type-18 and 12 type-16 cases. Among clinicians surveyed, 25% were aware of AGC subcategories, and only 11.9% were well-versed. Approximately 65% associated AGC with malignancy or precancerous lesions, and 52.6% used multiple diagnostic methods simultaneously. Even in the absence of neoplasia, 80% continued cytological examinations every 3-4 months. CONCLUSION: This study underscores the challenges in AGC management, highlighting the importance of follow-up and collaboration between clinicians and cytopathologists to detect significant lesions. It also emphasizes the need for providing learning opportunities for clinicians to address over/undertreatment.
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Adenocarcinoma , Padrões de Prática Médica , Displasia do Colo do Útero , Neoplasias do Colo do Útero , Esfregaço Vaginal , Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/patologia , Idoso de 80 Anos ou mais , Esfregaço Vaginal/estatística & dados numéricos , Adulto Jovem , Adenocarcinoma/patologia , Adenocarcinoma/diagnóstico , Padrões de Prática Médica/estatística & dados numéricos , Displasia do Colo do Útero/diagnóstico , Displasia do Colo do Útero/patologia , GinecologiaRESUMO
Introduction Simple hysterectomy (SH) is a frequently performed surgery for treating benign uterine conditions. The da Vinci® Surgical System (dVSS; Intuitive Surgical, Inc., Sunnyvale, California, US) received FDA approval in 2005 for robot-assisted minimally invasive gynecological surgeries. In Japan, insurance coverage for dVSS applications in benign uterine conditions, such as uterine myomas, began in 2018, driving a sharp rise in robotic procedures. The hinotori™ Surgical Robot System (hinotori; Medicaroid Corporation, Kobe, Japan), developed in Japan, was introduced in 2020. This study compares the operative results of SH performed by the hinotori and the dVSS. Methods A retrospective analysis was conducted on 40 patients who underwent SH for benign disease at Kagoshima University Hospital between 2017 and 2024. Surgical parameters, including operation times, cockpit or console times, and complication rates, were compared across the two systems. Results Median operation times and cockpit or console times for the hinotori were comparable to those of the dVSS, with no statistical differences observed. However, roll-in to cockpit or console initiation was significantly longer for the hinotori (P = 0.024) while hospital stays were notably shorter. Conversion rates to laparotomy and operative complications showed no significant differences among the groups. Conclusions The hinotori demonstrated surgical results equivalent to the dVSS, supporting its safety and effectiveness in SH for benign uterine conditions. Further studies are recommended to confirm these results.
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OBJECTIVE: To evaluate and compare the perioperative and oncologic outcomes of laparoscopic and robotic-assisted surgeries in patients with low-risk endometrial cancer who underwent minimally invasive surgery (MIS) for complete surgical staging, including sentinel lymph node mapping. METHODS: A retrospective study included 190 patients diagnosed with low-risk endometrial cancer who underwent MIS combined with sentinel lymph node navigation surgery (SNNS) between December 2016 and December 2021. Among these patients, 66 underwent laparoscopic surgery, while 124 underwent robotic-assisted surgery. The analysis focused on patient characteristics, perioperative outcomes, and prognostic factors, including recurrence-free survival (RFS) and overall survival (OS). Statistical analysis was performed using Kaplan-Meier survival curves and appropriate comparative tests for outcome evaluation. RESULTS: The median operative time and estimated blood loss were significantly longer and greater in the robotic surgery group than in the laparoscopic group (209.5 vs. 157.5 min, 20 vs. 5 mL, respectively). The identification rates of sentinel nodes were 97% and 95.2% in the laparoscopic and robotic groups, respectively, with no significant difference between the 2. Recurrence was observed in two and three cases in the laparoscopic robotic surgery groups, respectively. The 3-year RFS rates were 97.6% (95% confidence interval [CI]=0.8482-0.9769) and 93.9% (95% CI=0.9277-0.9922) for the robotic and laparoscopic groups, respectively, while the 3-year OS rates were 99.2% (95% CI=0.8561-0.9902) and 96.1% (95% CI=0.9450-0.9989), respectively, with no statistically significant differences. CONCLUSION: MIS combined with SNNS is a highly effective approach for managing low-risk endometrial cancer, providing comparable oncologic outcomes to laparoscopy while enhancing the quality of life of patients.
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Neoplasias do Endométrio , Laparoscopia , Procedimentos Cirúrgicos Robóticos , Humanos , Feminino , Neoplasias do Endométrio/cirurgia , Neoplasias do Endométrio/patologia , Neoplasias do Endométrio/mortalidade , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Laparoscopia/métodos , Laparoscopia/estatística & dados numéricos , Pessoa de Meia-Idade , Idoso , Linfonodo Sentinela/patologia , Linfonodo Sentinela/cirurgia , Biópsia de Linfonodo Sentinela/métodos , Adulto , Duração da Cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodosRESUMO
BACKGROUND: Prognostic predictors of immunotherapy in patients with advanced endometrial cancer remain unclear. The potential role of inflammatory predictors, including pretreatment neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and hemoglobin, albumin, lymphocyte and platelet scores, was investigated. METHODS: Between August 2018 and December 2023, 35 patients were retrospectively analyzed. Prognostic predictors were compared, and optimal cut-off values that exhibited the greatest discrimination for overall response, disease control, progression-free survival and overall survival were determined. Multivariate analysis was used to assess the prognostic significance of the predictors. RESULTS: The greatest discrimination for overall response, progression-free survival and overall survival included platelet-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio and hemoglobin, albumin, lymphocyte and platelet; the areas under the curve were 0.638, 0.649 and 0.641, respectively. The precise cut-off values of neutrophil-to-lymphocyte ratio for progression-free survival and overall survival were 4.92 and 5.40, respectively. The lower neutrophil-to-lymphocyte ratio group had a significantly longer progression-free survival (P = 0.001, median survival; 4.0 months vs. 19 months) and longer overall survival (P = 0.002, median survival; 5.0 months vs. 21 months). Of the risk factors assessed, neutrophil-to-lymphocyte ratio (hazard ratio = 4.409; 95% CI = 1.10-17.64; P = 0.036) and regimen (hazard ratio = 5.559; 95% CI = 1.26-24.49; P = 0.023) were independently correlated with overall survival. CONCLUSION: In patients with advanced endometrial cancer, pretreatment neutrophil-to-lymphocyte ratio may be a prognostic predictor of those who would benefit from immunotherapy.
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Neoplasias do Endométrio , Inibidores de Checkpoint Imunológico , Humanos , Feminino , Neoplasias do Endométrio/tratamento farmacológico , Neoplasias do Endométrio/patologia , Neoplasias do Endométrio/mortalidade , Neoplasias do Endométrio/imunologia , Prognóstico , Estudos Retrospectivos , Pessoa de Meia-Idade , Idoso , Inibidores de Checkpoint Imunológico/uso terapêutico , Neutrófilos , Adulto , Idoso de 80 Anos ou mais , Linfócitos , Intervalo Livre de ProgressãoRESUMO
OBJECTIVES: This study aimed to compare the surgical outcomes of simple hysterectomy with sentinel lymph node biopsy for low-risk endometrial cancer performed using the hinotori™ Surgical Robot System and the da Vinci® Xi system. MATERIALS AND METHODS: We retrospectively analyzed the data of 234 patients who underwent simple hysterectomy with sentinel lymph node biopsy at Kagoshima University Hospital between January 2017 and June 2024. Amongst them, 20 patients underwent surgery using the hinotori™ Surgical Robot System and 214 using the da Vinci® Xi. Surgical factors, including operative time, cockpit/console time, blood loss and sentinel lymph node detection, were evaluated. Statistical analyses included chi-square and Wilcoxon tests, with significance set at P < 0.05. RESULTS: The median operative and cockpit/console times were comparable between the two systems. However, the time from roll-in to the start of cockpit/console surgery was significantly longer for the hinotori™ Surgical Robot System than for the da Vinci® Xi (P = 0.0039). No significant differences were observed for blood loss, length of hospital stay, or complication rates. The sentinel lymph node detection rates and number of sentinel lymph nodes resected were similar between the two systems, with metastatic sentinel lymph node rates of 6% in both groups. CONCLUSION: Simple hysterectomy with sentinel lymph node biopsy performed using the hinotori™ Surgical Robot System demonstrated outcomes comparable with those using the da Vinci® Xi system, with no significant differences in key surgical factors. These results suggest that the hinotori™ Surgical Robot System is a viable alternative for minimally invasive surgery in low-risk endometrial cancer. Further studies with larger sample sizes are required to validate these findings.
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Phosphoglyceride crystal deposition disease is a rare condition occurring in soft tissues, resulting in scarring and affecting the bones, making preoperative differentiation from malignant tumors challenging. Here, we describe a case of phosphoglyceride crystal deposition disease initially suspected to be a malignant ovarian tumor before surgery. A 50-year-old woman with a history of three cesarean sections presented with lower abdominal pain. Transvaginal ultrasonography revealed a 54 × 58 mm tumor in the lower right abdomen. Pelvic contrast-enhanced magnetic resonance imaging showed a thickened cystic wall with diffusion restriction, a low signal intensity region on T1-weighted images, and a slightly high signal intensity region on T2-weighted images. The tumor markers, cancer antigen 125 and carbohydrate antigen 19-9 levels, were within normal ranges; however, positron emitting tomography-computed tomography revealed fluorodeoxyglucose accumulation (SUVmax 31.28) in the tumor wall. Suspecting a malignant ovarian tumor, a laparoscopy was performed to observe the abdominal cavity. A 10 cm white solid tumor was identified in the midline of the lower abdominal wall, leading to an open surgery recommendation. The tumor, adhering to the pubic bone, was excised. The tumor measured 9 × 7 cm, with the cut surface showing a yellow brownish solid periphery and central region with liquefied degeneration. Histologically, radial basophilic deposits, dense infiltration of macrophages, multinucleated giant cells, and foam-like tissue spheres were observed. The central region exhibited cholesterol clefts, fibrin exudation, and necrosis, leading to a diagnosis of phosphoglyceride crystal deposition disease. This disease is rare, occurring in patients with atypical fluorodeoxyglucose accumulation on positron emission tomography-computed tomography or with a history of tissue damage, such as abdominal surgery.
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OBJECTIVES: The high incidence of invasive cervical cancer among those who have not undergone cancer screening is a serious problem. This study aimed to investigate the utility of human papillomavirus (HPV) test results from self-collected urine and vaginal samples as screening tools. DESIGN: The study was conducted in two steps. First, the appropriate storage container, temperature, and time until urine HPV assay performance were verified. Second, the results of spot urine testing under those conditions and of gynecologist-collected cervical and self-collected vaginal samples were compared to verify the feasibility of using the BD Onclarity® HPV assay for individuals with abnormal cervical cytology. PARTICIPANTS/MATERIALS, SETTING, METHODS: The participants were 121 women with abnormal cervical cytology. Self-collected urine and vaginal samples, along with gynecologist-collected cervical samples, were tested for HPV using the BD Onclarity® HPV assay. The optimal conditions for urine sample storage were identified by comparing the HPV detection rates under various conditions. RESULTS: Urine stored in a BD Probe Tec™ (QxUPT) for less than 72 h at room temperature was found to have the highest HPV positivity rate. Under these conditions, the detection rates of HPV in urine, cervical, and vaginal samples were examined. HPV type 16 was detected in 41.7% of the cervical samples, type 18 in 10%, and types 31 and 52 in 12.6% each. The concordance rate for HPV testing between clinician-collected cervical and urine samples was 63.9% (kappa: 0.34; 95% CI: 0.21-0.47), and that between clinician-collected cervical and self-collected vaginal samples was 77.8% (kappa: 0.68; 95% CI: 0.53-0.83), indicating good concordance. In a population with an HPV-related lesion/tumor prevalence of approximately 70%, the sensitivity of HPV testing was 82.7% for the cervix, 46.4% for urine, and 75.7% for vaginal samples. LIMITATIONS: The primary limitation is the lower detection rate of HPV in spot urine samples than in other sample types, indicating room for methodological improvement. The study's findings are based on a specific population, which may limit generalizability. CONCLUSIONS: We investigated the optimal self-collected urine-to-testing time and temperature. Self-collected vaginal and urine HPV tests show moderate-high concordance with clinician-collected cervical HPV tests, suggesting their potential utility for women who do not undergo regular cancer screening. However, the sensitivity was not high in spot urine. Therefore, further large-scale studies are needed to verify these findings and optimize testing methods to encourage broader participation in cancer screening programs.
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BACKGROUND: Sentinel lymph node navigation surgery, which identifies the sentinel lymph node in early cervical cancers and omits systemic pelvic lymphadenectomy in cases where no lymph node metastasis is present, has recently gained attention. However, there are few reports on lymph node recurrence and the long-term outcomes of cervical cancer surgery performed using sentinel lymph node navigation surgery. In this study, we aimed to evaluate the long-term outcomes of sentinel node navigation surgery for early-stage cervical cancer. METHODS: One hundred thirty-eight patients with cervical cancer were enrolled. Sentinel lymph nodes were identified by injecting 99 m Technetium-labeled phytate and indocyanine green into the uterine cervix. Surgery and survival outcomes were also analyzed. RESULTS: The median age and body mass index of the patients were 40 years (20-78) and 21.7 kg/m2 (16.5-50.4), respectively. Open surgery, laparoscopic surgery, and robotic surgery were performed in 77 (56%), 53 (38%), and 8 (6%) patients, respectively. The overall and bilateral detection rates of the sentinel lymph node were 100% and 94%, respectively. Only one case (0.7%) exhibited lower extremity lymphedema, and pelvic lymphocele was observed in three cases (2.2%). Four cases (3%) experienced recurrence over a median follow-up of 57.5 months (range, 2-115 months), with five-year recurrence-free and overall survival rates of 97% and 97.3%, respectively. CONCLUSIONS: Our results demonstrate that sentinel node navigation surgery may be safe and effective for early-stage cervical cancer.
Assuntos
Excisão de Linfonodo , Biópsia de Linfonodo Sentinela , Linfonodo Sentinela , Neoplasias do Colo do Útero , Humanos , Feminino , Neoplasias do Colo do Útero/cirurgia , Neoplasias do Colo do Útero/patologia , Pessoa de Meia-Idade , Adulto , Linfonodo Sentinela/patologia , Linfonodo Sentinela/cirurgia , Idoso , Biópsia de Linfonodo Sentinela/métodos , Excisão de Linfonodo/métodos , Metástase Linfática , Estadiamento de Neoplasias , Procedimentos Cirúrgicos Robóticos/métodos , Verde de Indocianina/administração & dosagem , Recidiva Local de Neoplasia , Laparoscopia/métodos , Ácido Fítico , Adulto Jovem , Resultado do Tratamento , Compostos de OrganotecnécioRESUMO
Although exploratory laparoscopy in patients with advanced ovarian cancer is a diagnostic tool for determining treatment strategy, its safety has not been completely investigated. We report a case involving a severe abdominal abscess following an exploratory laparoscopy. A 65-year-old woman with advanced ovarian cancer developed a large abdominal abscess following exploratory laparoscopy and neoadjuvant chemotherapy. Emergent laparotomy was performed; while massive bowel adhesion surrounding the abscess did not allow for genital organ resection, an incision in the left port area was made to drain the abscess. The patient's chemotherapy was delayed because she experienced sub-ileus, postoperatively. Only a limited number of studies have been conducted on the safety of these techniques. This intense infection case emphasizes the need for further investigations into the safety of exploratory laparoscopy in patients with progressive diseases under heterogeneous conditions in real-world settings.
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Serous tubal intraepithelial carcinoma, serous tubal intraepithelial lesions (STILs), and the p53 signature are considered to be related to precursor lesions of high-grade serous carcinomas (HGSCs). However, the clinical significance and prognostic implications of these lesion types are currently unknown. We diagnosed three patients with STILs according to the morphological evaluation criteria and combined this with p53 and Ki-67 immunostaining. One patient had an HGSC of the ovary that was incidentally discovered at the time of ovarian cyst resection, and the HGSC in the other two patients was characterized after they underwent risk-reducing salpingo-oophorectomy. Herein, we present a report of three patients with STILs diagnosed based on clinical data and pathological findings, along with a review of the literature.