Japanese Journal of Gynecologic and Obstetric Endoscopy最新文献

{"title":"Development of the New Instrument for Ritracter and Bag with Multi-cylinder “Laparo-Poi System” in Laparoscopic Operation","authors":"哲郎 畑瀬, 弘子 岩下, 裕 大橋","doi":"10.5180/JSGOE.19.2_81","DOIUrl":"https://doi.org/10.5180/JSGOE.19.2_81","url":null,"abstract":"産婦 人科領域 におけ る腹腔鏡手術 は、保険点数 の加算 や腹腔鏡下筋腫核 出術 が保 険適応疾患 に加 えられ、 さらに後腹膜 リンパ節郭清 な どの革新的 な手法 が発表 され注 目を集めている。 当院においては1998年7月 より本格 的に腹腔鏡 手術 を導入 し子宮 ・卵巣良性腫瘍 に対 し積極的 に 手術 を展 開 している。 腹腔鏡手術 において は低侵 襲性 手術で はあるが、 長時間の手術 とな り、高価 なデ ィスポ製 品を使用 す る為 にコス トの問題 も大 きい1)。 そ こで手術 時 間の短縮 と手術経費の低減の為 に種 々の機器の開 発 を行 って きた2-7)。今 回、腸管圧 排 、組織 回収 装置Laparo-Poi(ラ バ ロポイ)シ ス テムを開発 し その有用性 を認 めたので報告する。 組織圧排鉗子 は術者の手の動作 を代用す る もの で、主に腸管 の圧排 に用い られる。 エ ン ドリ トラ ク トに代表 されるが種 々の形態 の物が ある。一方 摘 出物収納用 具エ ン ドキ ャッチ、エ ン ドパ ウチ、 キ ャッチパ ース、 リナバ ックそれに各 自が作成 し た ビニールバ ックな どが使用 されている。そ こで これ らの機能 を同時 にもつLaparo-Poi(ラ パ ロポ イ)シ ステムを開発 した。 す なわ ちLaparo-Poi(ラ バ ロポイ)シ ス テムは (1)市 販 の直径3mmの アル ミ棒 を 「はて な」 状 に加工 した圧排 棒、(2)直 径70mmの ポ リウ レタン製の袋(3)エ ン ドバ ックの挿入筒 の盲端 部 に直 径10mmの 穴 をあ け て 作 成 したMulticylinderの 器具 よ り構 成 され、それ らを状況 によ って組み合 わせ る事 によって腹 腔鏡手術 を円滑 に すすめ ることがで きる。 使用法の実際","PeriodicalId":325241,"journal":{"name":"Japanese Journal of Gynecologic and Obstetric Endoscopy","volume":"28 14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116053604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case of uterine corpus tumor resembling ovarian sex-cord tumor reached pregnancy after transcervical resection","authors":"功 尾谷, 敏子 谷本","doi":"10.5180/JSGOE.22.379","DOIUrl":"https://doi.org/10.5180/JSGOE.22.379","url":null,"abstract":"症例は30歳 、平成○年1月30日 に不正性器 出血 にて近医を初診 し、子宮頸部、内膜細胞診 は とも にクラスIIで あ り、経 腟エ コーにて子宮腔 内に粘 膜下筋腫 と考え られる腫瘍 を認めたため、2月15 日当科紹介 となった。未婚、未経妊 で、月経歴 は、 初経:13歳 、周期:25~30日 型、持 続:5~7日 間であ り、月経 関連障害 はなか った。家族歴、既 往歴 も特 記すべ きこ とはなか った。 当科 初診時、 子宮鏡、経腟エ コーお よびMRIに て長径約2cm、 突 出度が75%以 上 の後壁 よ り発生の子宮 粘膜下筋 腫 と考 えられる腫瘍(図1)を 認めたため、5月 10日 に子宮 鏡下腫瘍切 除術 を施行 した。手術 日は 本人 の都合 によ り、月経周期27日 目で手術 となっ た。体位は砕石位 、麻酔 はラ リンゲルマス ク使用 の全 身麻酔で行った。手術 中ヘ ガー ル1~12号 に て子宮頸管拡張 を行 ってか ら、径4.5mmの 子宮鏡 にて内腔 を観察 し、子宮腫瘍の位置、大 きさを確 認 した(図2)。 その後、 径8mmの モ ノポー ラ 図1手 術 前","PeriodicalId":325241,"journal":{"name":"Japanese Journal of Gynecologic and Obstetric Endoscopy","volume":"229 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116134617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of total laparoscopic hysterectomy for cervical intraepithelial neoplasia","authors":"Y. Kawai, K. Umemura, A. Kunishima, Ryosuke Uekusa, Seiko Matsuo, Satoru Katsuki, A. Yabuki, Keiiti Fujita, K. Kitami, Y. Ikeda, M. Takano, Mayumi Okada, H. Ando, M. Kawai","doi":"10.5180/JSGOE.32.184","DOIUrl":"https://doi.org/10.5180/JSGOE.32.184","url":null,"abstract":"Objective: In postmenopausal women, the cervix atrophies and retracts, thus making conization increasingly difficult, and results in a tissue specimen that is frequently inadequate. Total hysterectomy is recommended in patients with positive conization margins or cervical intraepithelial neoplasia (CIN) who do not desire children. In such patients, we performed total laparoscopic hysterectomy (TLH). The aim of this analysis was to confirm the efficacy of TLH for the","PeriodicalId":325241,"journal":{"name":"Japanese Journal of Gynecologic and Obstetric Endoscopy","volume":"465 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116161726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful laparoscopic resection of a massive retroperitoneal tumor.: A case report","authors":"Koyuki Uemura, Takeaki Saitake, Ryuichiro Yano","doi":"10.5180/jsgoe.38.1_81","DOIUrl":"https://doi.org/10.5180/jsgoe.38.1_81","url":null,"abstract":"","PeriodicalId":325241,"journal":{"name":"Japanese Journal of Gynecologic and Obstetric Endoscopy","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122290603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ovarian Inguinal Hernia Diagnosed and Resected by Laparoscopy: Case Report","authors":"C. Sasakura, S. Hirabuki, J. Matsuyama, Ayumi Matsuoka, T. Kurokawa, H. Sasaki, T. Hoshiba","doi":"10.5180/JSGOE.29.464","DOIUrl":"https://doi.org/10.5180/JSGOE.29.464","url":null,"abstract":"Objective: An ovarian inguinal hernia is extremely rare in adults, and it is usually associated with developmental defects of the genital tract. We present a case of a 95-year-old female with an inguinal hernia containing a huge ovarian tumor (20 cm in diameter). Patient: Because of the large inguinal bulge, the patient experienced difficulty in walking. She recalled that the inguinal bulge was approximately 2 cm in diameter when she first noticed it 35 years ago; in addition, it was reducible at that time. Abdominal CT scan revealed a solid inguinal tumor, which was possibly receiving its blood supply from the left ovarian artery. Laparoscopic exploration revealed that the hernia sac was covered by dense adhesions and contained the solid ovarian tumor as well as the left pelvic infundibular ligament. Following adhesiolysis, the ligament was transected laparoscopically. The ovarian tumor was removed through a skin incision. The redundant skin was trimmed; then, an open hernia repair was performed, using woven mesh. Her postoperative course was uneventful, and she was discharged on the fifth postoperative day. The histopathologic diagnosis of the tumor was a Sertoli cell tumor of the ovary. Conclusions: A steadily enlarging ovarian neoplasm can become incarcerated in the inguinal canal for a long period of time without strangulation occurring. Although it is rare, an ovarian inguinal hernia should be considered when a groin mass is encountered in an adult female.","PeriodicalId":325241,"journal":{"name":"Japanese Journal of Gynecologic and Obstetric Endoscopy","volume":"325 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122321133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Introduction of laparoscopic surgery in women with gynecologic malignancies: experience of initial 20 cases","authors":"光部 兼六郎, 真紀 石本, 聖美 木川, 征史 森脇, 正尊 工藤, 英司 野村","doi":"10.5180/JSGOE.22.191","DOIUrl":"https://doi.org/10.5180/JSGOE.22.191","url":null,"abstract":"後腹膜 リンパ節郭清 をその術式に含む婦人科悪 性腫瘍手術は、婦人科領域でもっとも高侵襲な手 術のひとつであ り、術中の大量出血や術後の疼痛、 膀胱 ・腸管機能障害など種々の合併症を比較的高 率に認める。術後の回復には時間を要 し、術後化 学療法 ・放射線治療開始の遅れや社会生活への復 帰困難が しば しば経験 される。婦人科悪性腫瘍に 対す る根 治的 な腹腔鏡下手術 はQuerleau1)、 Nezhat2)ら により1990年 代初頭 に初めて報告 さ れ、従来の開腹手術 と比較 して術中出血量ならび に合併症の低減、術後の早期回復と入院期間の短 縮など患者のQOLを 高められる可能性が示唆 さ れている3,4)。当科では2004年7月 より腹腔鏡下 婦人科悪性腫瘍手術を導入 し、現在までに20症例 を経験 した。本稿の目的は、腹腔鏡下婦人科悪性 腫瘍手術 を施行 した上記症例と当科で開腹悪性腫 瘍手術 を実施した20症例について、術中 ・術後経 過ならびに合併症の発生を検討 ・比較 し、当科で の腹腔鏡下婦人科悪性腫瘍手術導入の妥当性を検 証することである。","PeriodicalId":325241,"journal":{"name":"Japanese Journal of Gynecologic and Obstetric Endoscopy","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122426466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Educational application of laparoscopic assisted ovarial cystcectomy for senior residents","authors":"嘉明 古澤, 秀樹 己斐, 祐子 古賀","doi":"10.5180/jsgoe.23.214","DOIUrl":"https://doi.org/10.5180/jsgoe.23.214","url":null,"abstract":"後期研修医に対する手術教育において執刀症例 数の確保は重要である。しかし、近年の婦人科疾 患に対する内視鏡下手術の割合は増加傾向であり、 研修医の執刀症例の確保は困難 となってきつつあ る。かつて、産婦人科手術研修の初期段階で若手 医師達は開腹の卵巣腫瘍摘出術、付属器切除術、 子宮外妊娠手術などを通 じて手術手技の基本を教 育されてきた。 しか し、腹腔鏡下手術の普及によ りそれらの手術は開腹術から腹腔鏡下手術にとっ て変 わ り、比較的容易な開腹手術 は症例数が減少 しつつ ある。当院 における良性疾患 に対す る開腹 術 及び腹腔鏡下 手術 の症例数 、割 り合い は表1、 グラフ1に 示す通 りである。 今 回我 々は2004年 か ら当院に在籍 してい る2名 の後期研修医が執刀 した腹腔鏡補助下卵巣腫瘍摘 出術(Laparoscopic assisted ovarial cystectomy: 以下LAC)症 例 を検討 し、 この術式が後期研修医 へ の婦 人科手術の基礎教育 に適切 か どうか を考察 した。","PeriodicalId":325241,"journal":{"name":"Japanese Journal of Gynecologic and Obstetric Endoscopy","volume":"143 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122673773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immunohistochemical diagnostic confirmation and laparoscopic treatment for primary peritoneal pregnancy: A case report","authors":"Norihito Kamo, K. Ota, Tetsu Sato, H. Miura, M. Ueda, Shinji Nomura, S. Soeda, Toshifumi Takahashi","doi":"10.5180/JSGOE.36.2_278","DOIUrl":"https://doi.org/10.5180/JSGOE.36.2_278","url":null,"abstract":"We report a case of primary peritoneal pregnancy treated with laparoscopic surgery in a 24-year-old gravida 0 who was referred to our hospital with lower abdominal pain. Transvaginal ultrasonography did not reveal a gestational sac in the pelvis; however, a hyperechoic lesion suspicious for a pelvic hematoma was identified in the cul-de-sac. Her serum human chorionic gonadotropin (hCG) level was 6400 mIU/mL, and serum hemoglobin was 11.0 g/dL. Physical examination showed signs of peritoneal irritation. We performed laparoscopy, which revealed an unremarkable uterus, bilateral fallopian tubes, and bilateral ovaries. We collected 500 mL of blood from the abdominopelvic cavity, and evaluation revealed a peritoneal pregnancy with active bleeding. We removed the gestational tissue, and histopathological examination of the retrieved specimen confirmed villi. Her serum hCG level immediately decreased postoperatively. Finally, she was histopathologically diagnosed with a peritoneal pregnancy because syncytiotrophoblasts were observed adjacent to the peritoneum of the pouch of Douglas, following staining with collagen type IV, which is derived from the mesothelium.","PeriodicalId":325241,"journal":{"name":"Japanese Journal of Gynecologic and Obstetric Endoscopy","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122851557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative inflammatory response after laparoscopic radical hysterectomy in patients with early-stage cervical cancer","authors":"S. Mabuchi, Naoko Komura, Yuri Matsumoto, Mahiru Kawano, Takeya Hara, Misa Yamamoto, M. Kawata, Michiko Kodama, E. Kobayashi, T. Kimura","doi":"10.5180/jsgoe.35.1_46","DOIUrl":"https://doi.org/10.5180/jsgoe.35.1_46","url":null,"abstract":"Objectives: To investigate inflammatory responses after laparoscopic radical hysterectomy in Japanese women with early-stage cervical cancer. Methods: Clinical data of patients with early-stage cervical cancer treated with laparoscopic radical hysterectomy, between January 2013 and June 2018, were collected and retrospectively reviewed. The patients were classified into 2 groups: normal (patients without postoperative complications) and complication (patients who experienced postoperative complications) groups. Their postoperative leukocyte/neutrophil counts and C-reactive protein (CRP) levels (inflammatory markers) were evaluated. Finally, we investigated the clinical utilities of the inflammatory markers to predict postoperative complications using receiver-operating characteristic (ROC) analysis. Results: Fifty-three Japanese women underwent laparoscopic radical hysterectomy for early-stage cervical cancer. Postoperative complications occurred in 10 patients (18.9%). In the normal group, inflammatory markers peaked on postoperative day (POD) 1 and declined thereafter. Similarly, in the complication group, inflammatory markers peaked on POD 1 and declined on POD 3. However, they increased again thereafter, resulted in peaks on PODs 9–15. When the 2 groups were compared, inflammatory markers were significantly higher in the complication group than in the normal group. A leukocyte count >7280/μL, neutrophil count >6030/μL, or CRP level >0.4 mg/dL on POD 6 exhibited high sensitivities and specificities for the prediction of postoperative complications: leukocyte count (83.3%, 87.5%), neutrophil count (83.3%, 87.5%), or CRP level (100%, 56.3%), respectively. The negative predictive values of these markers were 93%, 93%, and 100%, respectively. Conclusion: Inflammatory responses after laparoscopic radical hysterectomy in Japanese women with early-stage cervical cancer were evaluated. Leukocyte/neutrophil counts or CRP levels on POD 6 are useful to predict postoperative complications, allowing for safe and early discharge.","PeriodicalId":325241,"journal":{"name":"Japanese Journal of Gynecologic and Obstetric Endoscopy","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122905470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Malignant Lymphoma, which was Diagnosed by Pelvic Lymph Node Biopsy during a Total Laparoscopic Hysterectomy: Case Report","authors":"Koichi Nagai, Kayo Katayama, Yuko Nakamura, M. Shimizu, Mayu Shimomukai, Yukari Matsuzaki, Yumi Ishidera, Yuka Oi, N. Ando, H. Shigeta, Hiroshi Yoshida","doi":"10.5180/JSGOE.30.459","DOIUrl":"https://doi.org/10.5180/JSGOE.30.459","url":null,"abstract":"We report a rare case of a malignant lymphoma that was diagnosed by pelvic lymph node biopsy during a total laparoscopic hysterectomy for cervical carcinoma in situ (CIS). The patient was a 65-year-old woman with an unremarkable past history. She was referred to our hospital because a cervical cancer screening revealed a high-grade squamous intraepithelial lesion (HSIL). A cervical biopsy revealed squamous cell carcinoma in situ, which was confirmed by cervical conization. Moreover, she complained of an enlarged lymph node in her left neck. For this reason, she was referred to the department of otorhinolaryngology six days after the conization. Although fine-needle aspiration cytology of the cervical lymph node was performed twice, the results were negative. Because she refused a lymph node biopsy, antibiotics were given under the presumptive diagnosis of cat scratch disease. We recommended a total laparoscopic hysterectomy for the cervical CIS after providing informed consent. During the procedure, we biopsied a right obturator lymph node, which was noted to be enlarged with a pelvic MRI. Histologic examination revealed no residual tumor in the cervix; however, the lymph node was diagnosed as a grade 2 follicular lymphoma. She was subsequently diagnosed as a stage III malignant lymphoma (Ann Arbor classification) and is currently receiving R-CHOP chemotherapy in department of hematology. In our experience, laparoscopic lymphadenectomy is useful not only for the diagnosis of gynecological malignancies but also for the diagnosis of non-gynecological malignancies. Laparoscopic surgery can determine the cause of lymph node enlargement within the scope of less invasive surgery.","PeriodicalId":325241,"journal":{"name":"Japanese Journal of Gynecologic and Obstetric Endoscopy","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122473744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}