Kota Yamauchi

Multidirectional Traction Method Using SURGICEL NU-KNIT and Surgical Suture in Robot-assisted Laparoscopic Surgery for Endometrial Cancer

To describe a novel approach to robot-assisted laparoscopic total hysterectomy (RH) for endometrial cancer that minimizes cancer sell spillage and develops a stable surgical field. Demonstration of the multidirectional traction method with narrated video footage. Many reports have indicated that RH for endometrial cancer has the same or superior short-term results compared with conventional laparoscopic hysterectomy (LH), and the long-term prognosis is the same [1,2]. However, there are no randomized controlled trials of RH versus LH, and some previous reports [3] have suggested that RH has a worse prognosis than LH, so the long-term prognosis should be considered with caution. Factors that may affect the long-term prognosis include the use of uterine manipulators [4] and compression of the uterine body with robotic forceps without tactile sensation [3]. However, to the best of our knowledge, no surgical technique capable of avoiding these factors has been established yet. Herein, we report a multidirectional traction method using SURGICEL NU-KNIT (Ethicon; Johnson & Johnson Medical Ltd., Tokyo, Japan), a local hemostatic agent, and surgical sutures. Cut 2-0 Prolene (Ethicon; Johnson & Johnson Medical Ltd., Tokyo, Japan) with straight needles (ST-70) thread to 35 cm, stick a 1 × 2 cm piece of SURGICEL NU-KNIT, and make knots Fig. 1. This implement is used to puncture the incisional margins of the peritoneum and then the abdominal wall to bring the thread to the surface of the body, where it is grasped with forceps and fixed. By repeating this operation, multidirectional traction can be obtained Fig. 2. A manipulating suture is also attached to the uterus to minimize the compression of the uterine body with robotic forceps. The multidirectional traction method allows for reproducible stable surgical field development and minimizes cancer cell spillage by reducing uterine grasping by robotic forceps without the use of uterine manipulators.

Efficacy of Sentinel Lymph Node Sampling for Early Cervical Cancer: A Single Institute Study

ABSTRACT Aim Radioisotope (RI) tracers were approved for use in gynecological cancers in Japan in 2023, and their application in sentinel lymph node (SLN) biopsy for cervical cancer is expected to expand. Our institution has been performing SLN biopsies for cervical cancer since 2009. This study aimed to evaluate the efficacy and safety of SLN biopsy in patients with early‐stage cervical cancer. Methods This study included 136 patients with FIGO 2008 stage IA1 to IB1 cervical cancer who underwent hysterectomy with SLN mapping between January 2009 and December 2023. The SLNs were identified using a combination of RI and dye (patent blue) methods. Systematic pelvic lymph node dissection (PLND) was performed during the initial introduction period. Patients were divided into two groups: the PLND group ( n  = 50), who underwent systematic dissection until August 2012, and the sentinel node navigation surgery (SNNS) group ( n  = 86), who underwent SLN biopsy with systematic dissection only when SLN metastasis was detected. Recurrence, prognosis, and complications were compared between the groups. Results In the PLND group, the SLN detection rate was 84%, and the sensitivity for detecting lymph node metastasis was 100%. Lymphedema occurred in 5.8% and 20.0% of patients in the SNNS and PLND groups, respectively. The 5‐year progression‐free survival rates in the SNNS and PLND groups were 88.6% and 92.2% respectively. The 5‐year overall survival rates were 95.5% and 97.8%, respectively, with no significant differences observed. Conclusion SLN biopsy can improve the quality of life without compromising oncologic outcomes in early‐stage cervical cancer.

Possible overestimation of treatment effects of pelvic and para-aortic lymphadenectomy for early-stage ovarian clear cell carcinoma: a retrospective propensity-score weighted multi-center cohort study

The treatment effects of lymphadenectomy in early-stage ovarian clear cell carcinoma (OCCC) reported in previous studies may have been overestimated owing to confounding factors. This study aimed to investigate the treatment effect of pelvic and para-aortic lymphadenectomy (PeNPAN) in early-stage OCCC, with careful adjustment for potential confounders. This retrospective multi-center cohort study involved women with preoperatively suspected stage I OCCC. We included patients who underwent surgery for OCCC between 2005 and 2019 at 11 affiliated institutions. The exposure (PeNPAN) group comprised patients who underwent PeNPAN. The primary outcome was disease-free survival (DFS). Additionally, hazard ratios (HRs) of lymphadenectomy for DFS were estimated using unadjusted and propensity score-weighted Cox regression models and biased models applied in previous studies. To identify strong confounders, we further examined factors associated with recurrence that differed between the groups. We analyzed 304 women who underwent surgery for preoperatively suspected stage I OCCC. The unadjusted HR for DFS was 0.63 (95% confidence interval [CI]=0.36-1.09; p=0.10), and the propensity-score adjusted HR was 0.82 (95% CI=0.42-1.58; p=0.55). The biased model showed a statistically significant HR of 0.59 (95% CI=0.36-1.00; p=0.048). Adhesions in the Douglas' pouch and cardiovascular disease were associated with recurrence and were more prevalent in the control group, suggesting potential confounders. After adjusting for potential confounders, the observed treatment effects of lymphadenectomy in the biased models were no longer statistically significant. Future investigations should carefully account for possible confounders, including intraoperative adhesions and comorbidities.