Fuminori Taniguchi

A Novel Port and Arm Placement Strategy for the Hugo Robotic‐Assisted Surgery ( RAS ) System in Gynecologic Oncology: Initial Experience and Technical Considerations

ABSTRACT Introduction The Hugo robotic‐assisted surgery (RAS) system is a novel surgical platform that expands the potential for minimally invasive procedures in gynecologic oncology. Early studies have shown promise, but the optimal configuration of ports and robotic arms requires further clarification. This study aimed to introduce a refined strategy for optimizing port placement and robotic arm arrangement with the Hugo RAS system and compare its performance to previously employed configurations. Materials and Surgical Technique Initial experiences in two cases of early‐stage endometrial cancer are presented. A new configuration was developed through iterative discussions and a review of emerging Hugo RAS literature. Port placement and arm arrangement with three arms on the patient's right side and one on the left—were designed to expand the assistant's working space. Two patients with stage IA endometrial cancer underwent surgery with this approach. Operative times, blood loss, and procedural details were evaluated. Discussion Both procedures were completed successfully with improved instrument articulation, reduced arm collisions, and enhanced workflow. Compared with previous strategies, this new configuration provided better ergonomics, minimized interference between robotic and assistant instruments, and expanded the operative field for both the first and second assistants, enabling smoother transvaginal specimen retrieval. Initial findings suggest that optimizing both port placement and arm settings enhances the surgical environment for the Hugo RAS system and may improve procedural efficiency and patient outcomes. Further studies with larger cohorts are warranted to validate these findings and potentially establish standardized guidelines.

Cancers associated with extraovarian endometriosis at less common/rare sites: A nationwide survey in Japan

AbstractAimEndometriosis mostly affects the ovary but can also be present outside of the ovary including the pelvic peritoneum, intestine, urinary tract and lung. In case of ovarian endometriotic cyst, an increased risk of ovarian cancer, especially of clear cell and endometrioid histology, has been reported. However, because of the rarity, cancer occurrence from endometriosis at less common sites/rare sites is poorly understood.MethodsWe conducted a nationwide survey on the less common/rare site endometriosis in 3539 authorized facilities in Japan. We requested to complete a case report form for each case, including information on the history of endometriosis, treatment for endometriosis, type of surgery, involved site(s) of cancer and endometriosis, histology of cancer, chemotherapy and outcome.ResultsOut of 1397 confirmed cases of less common/rare site endometriosis, 11 cases of rare site endometriosis‐associated cancer (RSEAC) were reported: seven of them were associated with intestinal endometriosis, three were associated with urinary tract endometriosis and one was associated with umbilical endometriosis. Interestingly, the histology was endometrioid in seven (64%) cases, and serous, seromucinous borderline, clear cell and mucinous in one case each (10%), differing from the case of ovarian endometriosis‐associated cancer, in which clear cell carcinoma are more common.ConclusionOur nationwide survey on RSEAC has revealed that: (i) the incidence of malignant transformation may be lower than ovarian endometriosis, (ii) malignant transformation from endometriosis outside the abdominal cavity may be extremely rare and (iii) the histology of RSEAC is predominantly endometrioid type, suggesting an association of a hormonal effect.

Characterization of immortalized ovarian epithelial cells with BRCA1/2 mutation

We aimed to elucidate the mechanism underlying carcinogenesis by comparing normal and BRCA1/2-mutated ovarian epithelial cells established via Sendai virus-based immortalization. Ovarian epithelial cells (normal epithelium: Ovn; with germline BRCA1 mutation: OvBRCA1; with germline BRCA2 mutation: OvBRCA2) were infected with Sendai virus vectors carrying three immortalization genes (Bmi-1, hTERT, and SV40T). The immunoreactivity to anti-epithelial cellular adhesion molecule (EpCAM) antibodies in each cell line and cells after 25 passages was confirmed using flow cytometry. Chromosomes were identified and karyotyped to detect numerical and structural abnormalities. Total RNA extracted from the cells was subjected to human transcriptome sequencing. Highly expressed genes in each cell line were confirmed using real-time polymerase chain reaction. Immortalization techniques allowed 25 or more passages of Ovn, OvBRCA1, and OvBRCA2 cells. No anti-EpCAM antibody reactions were observed in primary cultures or after long-term passages of each cell line. Structural abnormalities in the chromosomes were observed in each cell line; however, the abnormal chromosomes were successfully separated from the normal structures via cloning. Only normal cells from each cell line were cloned. MMP1, CCL2, and PAPPA were more predominantly expressed in OvBRCA1 and OvBRCA2 cells than in Ovn cells. Immortalized ovarian cells derived from patients with germline BRCA1 or BRCA2 mutations showed substantially higher MMP1 expression than normal ovarian cells. However, the findings need to be validated in the future.