Takashi Ushiwaka

One-step nucleic acid amplification (OSNA) assay for detecting lymph node metastasis in cervical and endometrial cancer: a preliminary study

To evaluate the accuracy of the one-step nucleic acid amplification (OSNA) assay for the diagnosis of lymph node (LN) metastasis in uterine cancer. A total of 116 LNs from 30 patients with cervical and endometrial cancer, enrolled in this prospective study, were used. Excised LNs were cut into 4 to 6 blocks at 2 mm intervals, and nonadjacent blocks were alternately subjected to either histological examination or the OSNA assay. The concordance rate between histological examination and the OSNA assay in cervical cancer and in endometrial cancer was 95.9% and 95.2%, respectively. The sensitivity, specificity, and negative predictive value of the OSNA assay were 80%, 97.7%, and 97.7% in cervical cancer, and 85.7%, 93.3%, and 98.2% in endometrial cancer, respectively. In cervical cancer, discordant results were observed in 2 out of 49 LNs (4.1%); 1 was OSNA assay-positive and histological examination-negative, and 1 was OSNA assay-negative and histological examination-positive. In endometrial cancer, discordant results were observed in 5 out of 67 LNs (7.5%); 4 were OSNA assay-positive and histological examination-negative, and 1 was OSNA assay-negative and histological examination-positive. The OSNA assay showed high concordance rate with histological examination, sensitivity, and specificity in uterine cancer, suggesting that it could enhance the accuracy of conventional pathological examination for the detection of LN metastasis by reducing false negative rate.

Robotic dual-docking surgery for para-aortic lymphadenectomy in endometrial cancer: a prospective feasibility study

Abstract Background The standard for robotic para-aortic lymphadenectomy has not been fully established. Para-aortic lymphadenectomy performed by sharing the same ports with pelvic procedures, a procedure known as dual-docking surgery, can be performed using the latest robotic system. We prospectively examined the ability of standardized dual-docking robotic surgery in endometrial cancer patients. Methods This study prospectively verified the feasibility and safety of dual-docking robotic surgeries performed between March 2017 and December 2021. The laterally placed ports were aligned with the umbilicus. Primary outcome was the surgical completion rate; secondary outcomes were blood loss, operative time, unexpected port placement, conversion, complications, length of hospital stay, and survival. Results Most patients (14/15, 93%) underwent surgery using our methods without additional port placements, and one patient was converted to laparotomy. Median blood loss was 162 mL (range: 20–685 mL). Median operative time was 183 and 206 min in the upper and lower abdomen. Median number of resected para-aortic lymph nodes was 19 (range: 6–29), and pelvic lymph nodes was 28 (range: 15–42). Although there was no difficulty in moving the forceps intraoperatively, major complications including vessel injury, and pelvic abscesses were observed. The lateral ports could be placed 6–10 cm apart in patients with any range of body type. Conclusion Dual-docking surgery for endometrial cancer has the potential to be a standard procedure for robotic endometrial cancer surgery, although a greater number of cases are needed to acquire proficiency.

Robotic trachelectomy with sentinel lymph node biopsy for cervical cancer: a prospective study investigating minimally invasive radicality

Abstract Objective The importance of minimally invasive fertility-sparing surgery for cervical cancer is gaining increasing interest, both to achieve a cure and for future fertility. Procedures for robotic radical trachelectomy involving uterine reconstruction are not fully established. Methods This study prospectively verified the feasibility and safety of robotic radical trachelectomy between February 2018 and May 2022. The criteria were almost identical to those for our standard abdominal radical trachelectomy. Larger tumors (> 2 cm in diameter) were acceptable for surgery, provided a secure ≥ 1 cm cancer-free space was identified between the tumor and internal os. Results Eight patients (median age, 32 y) were registered; the median body mass index was 21.8, and the median tumor size was 11.5 mm (range 0–30 mm). Robotic radical trachelectomy could be achieved in all patients with hybrid sentinel lymph node navigation surgery, confirming the precise cervical amputation line with a newer small knob ultrasonography probe, adequate cervical cerclage with non-absorbable monofilament stitches, and avoiding looseness between vaginal–uterine anastomosis with uninterrupted barbed U-shaped sutures. None of the cases were converted to laparotomy or radical hysterectomy, and there were no major complications. The median follow-up period was 49.5 mo (range 21–58 mo) and no patient had disease recurrence. Conclusion Robotic radical trachelectomy is safe and feasible using newer technologies without reducing radicality; it is also less invasive. Procedures are consistently reproducible and have the potential to be generalized to minimally invasive approaches.