Objective: Since 2021, we have introduced vNOTES （Transvaginal Natural Orifice Transluminal Endoscopic Surgery） for Reduced Port Surgery in laparoscopic total hysterectomy. The vNOTES uses a natural vaginal orifice, which is less painful and more aesthetic. However, performing surgery for severe adhesions and narrow vaginas is challenging; thus, case selection is essential. Therefore, we started Hybrid vNOTES with umbilical port and have performed it in seven cases to date. In this study, we retrospectively reviewed these cases and compared the surgical results with those of conventional multiport laparoscopic surgery.

BACKGROUND/AIM:Ovarian seromucinous tumor is a histological type of ovarian neoplasm. Although seromucinous borderline tumors (BSMT) are associated with endometriosis, the frequency of their occurrence is low, and many aspects of their behavior remain unclear. In this study, we aimed to clarify the clinicopathological factors of BSMT.PATIENTS AND METHODS:We retrospectively reviewed 32 patients with pathologically diagnosed BSMT who underwent surgery at Jikei University Hospital. The survey items were patient characteristics, such as age, initial symptoms, preoperative tumor markers, surgical procedure and stage of surgery, presence of endometriosis, and recurrence.RESULTS:The median age was 45 years. Lower abdominal pain was the most common chief complaint, about one-third of patients were asymptomatic; one-sixth were discovered during follow-up for endometriosis. The majority had a high serum CA19-9 level. Twenty-five patients (78.1%) had unilateral masses, whereas seven patients (21.9%) had bilateral masses. More than 90% of the cases had coexisting endometriosis histologically. Thirty cases (93.8%) were stage I, only two were stage II, and none were stage III or IV. Recurrence was observed in two cases: one was borderline malignant and the other was a carcinoma.CONCLUSION:BSMT is a rare form of borderline malignancy. Its preoperative diagnosis is often difficult because of various clinical findings, but a history of endometriosis and an elevated serum CA19-9 level may aid in some cases.

Objectives: Although atypical endometrial hyperplasia (AEH) is considered a precancerous disease, the frequency with which AEH and endometrial cancer (EC) coexist is not low. Broadly, total laparoscopic hysterectomy (TLH) is performed for treating AEH; however, it is unclear what perioperative precautions need to be taken. This study aimed to clarify the points to be considered when performing TLH for AEH. Materials and Methods: We retrospectively identified 57 patients who underwent TLH for AEH in our hospitals. We extracted data on clinical characteristics, preoperative examinations (endometrial sampling and diagnostic imaging), surgical procedures, and final pathological diagnoses. Then, we statistically analyzed the difference in clinicopathological features and preoperative examinations between patients postoperatively diagnosed with EC and those diagnosed with AEH. Results: Twenty patients (35%) who underwent TLH for AEH were diagnosed with EC postoperatively (16 [28%] with stage IA EC and four [7.0%] with stage IB EC). We found no significant differences in clinical characteristics and preoperative evaluations between patients postoperatively diagnosed with EC and those diagnosed with AEH. The group with stage IB EC had a significantly higher median age and a significantly higher proportion of postmenopausal patients and patients with adenomyosis. Conclusion: It is important to recognize the risk of coexisting EC when performing TLH for AEH. High-precision endometrial sampling and contrast-enhanced magnetic resonance imaging are recommended for diagnosing AEH. In addition, surgical procedures for AEH are required to prevent cancer spillage in consideration of its coexistence, such as tubal sealing before manipulator insertion or avoiding using manipulator.

FtsJ RNA 2'-O-methyltransferase 1 (FTSJ1) gene has been implicated in X-linked intellectual disability (XLID), but the molecular pathogenesis is unknown. We show that Ftsj1 is responsible for 2'-O-methylation of 11 species of cytosolic transfer RNAs (tRNAs) at the anticodon region, and these modifications are abolished in Ftsj1 knockout (KO) mice and XLID patient-derived cells. Loss of 2'-O-methylation in Ftsj1 KO mouse selectively reduced the steady-state level of tRNA(Phe) in the brain, resulting in a slow decoding at Phe codons. Ribosome profiling showed that translation efficiency is significantly reduced in a subset of genes that need to be efficiently translated to support synaptic organization and functions. Ftsj1 KO mice display immature synaptic morphology and aberrant synaptic plasticity, which are associated with anxiety-like and memory deficits. The data illuminate a fundamental role of tRNA modification in the brain through regulation of translation efficiency and provide mechanistic insights into FTSJ1-related XLID.

Well differentiated papillary mesothelioma, WDPM is a benign rare tumor. The longterm prognosis and characteristics of the disease are still unclear. We report a case of unifocal WDPM, two-millimeter in the greatest dimension, which was incidentally found in the small bowel mesentery during laparoscopic surgery for endometrial cancer. The patient is a woman in her 40s with no history of pregnancy. She was on hemodialysis for chronic renal failure due to type 2 diabetes and was consulted for anemia due to menorrhagia. Endometrioid carcinoma grade1 of uterine endometria was diagnosed by performing a total endometrial scraping. There was no tumor found in endometrium lesion on MRI study, and CT showed negative lymphadenopathy and distant metastasis. Laparoscopic hysterectomy and bilateral salpingo-oophorectomy were performe d. During operation, a small tumor was found on the small bowel mesentery during observation after hysterectomy and it was completely resected. Careful observation around the tumor was performed and no other tumors were found. The postoperative pathological diagnosis was endometrial carcinoma clinical stage IA, and WDPM for a small tumor on bowel. The patient is being followed up without any post treatment, and both endometrial cancer and WDPM have passed without recurrence. Complete resection of tumor, judicious sampling and immunohistochemistry, and careful histopathological diagnosis is necessary for WDPM. When mesentery tumor is accidentally found during laparoscopic surgery for gynecological diseases, careful resection would help us to detect small tumors such as WDPM.

BACKGROUND/AIM:Hypersensitivity reactions (HSRs) to carboplatin, a key drug for ovarian cancer patients, are problematic. The aim of this study was to evaluate the efficacy and safety of readministration of platinum agents (PTs) in recurrent ovarian cancer patients who developed HSRs to carboplatin.PATIENTS AND METHODS:Thirty-one patients with recurrent ovarian cancer who developed HSRs to carboplatin were divided into those who continued to receive PTs in the following cycle (continuation group, n=24) and those in whom either the drug was switched to non-platinum agents (non-PTs) or chemotherapy was ended (discontinuation group, n=7). Outcomes were evaluated based on patients' medical records.RESULTS:The median survival time following HSRs was 28.1 and 15.4 months in the continuation and discontinuation groups, respectively (p=0.018). In the continuation group, a total of 155 cycles of PTs were re-administrated, and 50 cycles (32%) led to recurrent HSRs. There were no recurrent HSRs with a severity of grade 3 or greater.CONCLUSION:Continuation of PTs in ovarian cancer patients may contribute to improvement in their overall survival without severe recurrent HSRs.

Objective: Intestinal obstruction and infertility are significant adverse effects related to the formation of postoperative adhesions after gynecological surgery. INTERCEED (Ethicon) and Seprafilm (Kaken Pharmaceutical Co., Ltd.) are widely used adsorbable-type adhesion barriers suited for open surgery. However, in December 2016, AdSpray (Terumo), a spray-type adhesion barrier that allows the insertion of a long nozzle through a trocar, became available for use in Japan. We studied the utility of AdSpray during laparoscopic surgeries. Methods: We studied 37 patients who underwent a total laparoscopic hysterectomy at our hospital between April 2016 and August 2017. Patients were categorized into 2 groups to receive either AdSpray or INTERCEED. A retrospective intergroup comparison was performed based on the distribution/adhesion time, white blood cell count, and the C-reactive protein levels on day 1 postoperatively, and the number of days hospitalized after surgery. Results: The AdSpray group showed a shorter distribution/adhesion time than the INTERCEED group (118 ± 25 s vs. 170 ± 61 s, respectively, p = 0.013). No significant differences were observed in terms of any other outcomes. Neither group showed perioperative complications. Conclusion: The tip of the nozzle of AdSpray can be bent freely to allow passage through the trocar for distribution over uneven surfaces. Thus, AdSpray is easier and safer to use during laparoscopic surgeries than adsorbable-type

OBJECTIVE:Since there have been few large series studies to date, we investigated the relationship between Trousseau's syndrome associated with cerebral infarction and its clinical associations with ovarian cancer.METHODS:In this study, we investigated the association between cerebral infarction onset and ovarian cancer. Eight-hundred twenty-seven consecutive ovarian cancer patients from 4 affiliated academic institutions were included in the study over a 12 years period. All patients were histopathologically diagnosed as epithelial ovarian cancer and were analyzed retrospectively.RESULTS:The 27 patients (3.2%) presented with cerebral infarction during the study period, 14 patients onset prior to treatment (1.7%), and 13 patients onset after start of initial treatment (1.5%). Univariate analysis and multivariate analysis was performed for onset of Trousseau's syndrome and various clinical and pathological parameters. There was no statistical significance between the occurrence of Trousseau's syndrome with age or International Federation of Gynecology and Obstetrics (FIGO) stage; however, univariate analysis and multivariate analysis demonstrated a statistically significant association between clear cell carcinoma (CCC) and non-CCC histology.CONCLUSION:Thus, our results demonstrate that Trousseau's syndrome with cerebral infarction occurred with greater incidence among CCC cases compared to non-CCC cases.

Study Objective: To describe Higuchi's transverse incision and a modification of this method for reduced port surgery (RPS).Design: Descriptive study.Setting: University hospital.Patients: Those with ovarian cyst and uterine myoma.Intervention: A platform is placed in the 2-3 cm Higuchi incision just above the pubis or on the pubis. Blunt dissection of the subcutaneous adipose tissue is performed. A T incision of the rectus abdominis fascia and a longitudinal incision of the peritoneum are performed. A LAP PROTECTOR and EZ access (Hakko Medical, Nagano, Japan) are used with the platform for single-incision laparoscopic surgery. The peritoneum and fascia are closed by continuous suture, and the skin is closed using the dermostitch technique.Main Results: Higuchi's transverse incision is 2-3 cm in length and is made at a much lower position than the conventional Pfannenstiel transverse incision. The wound is covered by pubic hair, yielding an excellent esthetic outcome. The T incision of the rectus abdominis fascia secures a more extensive surgical field than the Pfannenstiel transverse incision.Conclusion: Higuchi's modified transverse incision ensures a sufficient visual field, yields an excellent esthetic outcome, and is safe, suggesting the potential use of this method for RPS. Copyright (C) 2017, The Asia-Pacific Association for Gynecologic Endoscopy and Minimally Invasive Therapy. Published by Elsevier Taiwan LLC. This is an open access article under the CC BY-NC-ND license.

There has been significant progress in the understanding of the pathology and molecular biology of rare ovarian cancers, which has helped both diagnosis and treatment. This paper provides an update on recent advances in the knowledge and treatment of rare ovarian cancers and identifies gaps that need to be addressed by further clinical research. The topics covered include: low-grade serous, mucinous, and clear cell carcinomas of the ovary. Given the molecular heterogeneity and the histopathological rarity of these ovarian cancers, the importance of designing adequately powered trials or finding statistically innovative ways to approach the treatment of these rare tumors has been emphasized. This paper is based on the Rare Ovarian Tumors Conference for Young Investigators which was presented in Tokyo 2015 prior to the 5th Ovarian Cancer Consensus Conference of the Gynecologic Cancer InterGroup (GCIG).

Objective: Higuchi's transverse incision is made at a lower position than the Pfannenstiel transverse incision and is superior in terms of cosmetic outcomes. The purpose of this study was to examine the safety and efficacy of novel forms of reduced port surgery for ovarian cysts and uterine fibroids applying Higuchi's transverse incision.Methods: In 33 patients with ovarian cysts who underwent low-position single-incision laparoscopic surgery (L-SILS)-modified single-port laparoscopy placed in the 2-3-cm Higuchi's incision above the pubis, patient's characteristics and perioperative outcomes were compared with those of patients who underwent multiport laparoscopy (n = 53). In addition, 18 patients with uterine fibroids who underwent dual-port laparoscopically assisted myomectomy without using power morcellators and conventional four-port laparoscopically assisted myomectomy were investigated.Results: There were no significant differences between L-SILS and multiport laparoscopy in tumor diameter, bleeding, hospital stay, or postoperative pain. However, the L-SILS group demonstrated significantly shorter operative and pneumoperitoneum times (p < 0.01 and p < 0.01). In comparison with cases of uterine fibroids, no significant differences were found in maximum fibroid diameter, operative time, pneumoperitoneum time, or bleeding. However, the dual-port laparoscopically assisted myomectomy group demonstrated a significantly shorter length of hospital stay than the conventional laparoscopically assisted myomectomy group (p < 0.05).Conclusion: We reported novel forms of reduced port surgery applying Higuchi's transverse incision. It was suggested that these procedures are relatively simple, but ensure the same safety and efficacy as conventional methods. We intend to increase the number of cases and examine safety, efficacy, and patient satisfaction for these procedures. Copyright (C) 2016, The Asia-Pacific Association for Gynecologic Endoscopy and Minimally Invasive Therapy. Published by Elsevier Taiwan LLC.

Massive ovarian edema is a rare condition in which intermittent torsion of the ovary at its pedicle obstructs venous and lymphatic drainage and results in the development of edema in the ovarian stroma. Massive ovarian edema occurs in young women, and most women undergo oophorectomy or wedge resection of the ovary to verify the presence of a neoplasm. We report a case of massive ovarian edema with torsion in a patient who underwent laparoscopic surgery with preserved ovarian function. It is clinically important to make a diagnosis appropriately and rapidly to prevent unnecessary oophorectomy and preserve ovarian function.