Placental polyps are thought to be derived from placental remnants after conception. Placental polyps are managed primarily by surgery, including hysterectomy and hysteroscopic resection. There is no specific recommendation regarding the optimal treatment to preserve fecundity. A 27-year-old primigravida presented at 38 weeks gestation and underwent a vaginal delivery. This delivery was complicated by massive hemorrhage due to uterine atony. Four weeks later the patient had a vaginal expulsion of a placental polyp after oral administration of ergometrine. A conservative surgical treatment under general anesthesia involved manual excision of the polyp and hysteroscopic hemostasis. Placental polyps are rare entities encountered in obstetric care; however, postpartum hemorrhage can be associated with this pathologic condition. Uterine stimulants and hysteroscopy may be useful for preserving fertility.

抄録全体を表示

A case report: We will report on a case which suffered from right hydronephrosis after total laparoscopic hysterectomy. In addition, the same patient encountered a strangulated ileus by internal hernia after ureteroneocystostomy and mechanical ileus after that surgery. The patient was a-56-year-old-woman with regular menstruation who underwent the laparoscopic hysterectomy and bilateral adnexectomy. On the 32th postoperative day observations showed that the stenosis of the ureter had caused hydronephrosis on the right side and a ureteral stent was placed. As the stent placement did not solve the stricture after some months, laparoscopic ureteroneocystostomy using both the Boari flap and psoas hitch techniques to cover the large ureteral defect, was performed on the 7th month after the initial surgery. On the 43rd post-operative day after the uteroneocystostomy, the patient suffered severe pain due to an internal hernia between the space of the bladder and the iliopsoas muscle, and underwent a laparotomy by general surgeons to resolve strangulation of the bowel. As the post-operative course was unfavorable, she underwent her 4th surgery, a laparotomy for bowel obstruction because of adhesion of the bowel to the previous dissection site.
  Hydronephrosis is one of the more common complications after total laparoscopic hysterectomy and sometimes the course of treatment can become difficult. This patient is a rare case in that a domino effect of complications occurred after each stage of treatment and surgery. This case highlights the need for strict observation and management of all cases, to prevent extension of the course of treatment of the original disease.

抄録全体を表示

A paraovarian tumor of borderline malignancy is rare, forming 2-3% of paraovarian tumors. We presented a 35-year-old woman with a paraovarian tumor of borderline malignancy. Pelvic ultrasonography and MRI revealed a right-sided, 6-cm cystic adnexal mass. Laparoscopy showed a paraovarian tumor, and laparoscopic cystectomy without rupture was the initial treatment. Pathologic examination revealed borderline malignancy. Thirty-five days after the surgery, right salpingo-oophorectomy, biopsy of the omentum and peritoneum, and peritoneal washing were performed via laparoscopy. All histological and cytological findings were negative. The patient showed no clinical evidence of the disease over 36 months after the first treatment. Diagnosis and operative procedure of this tumor were discussed in this report.

抄録全体を表示

  Vaginal evisceration after hysterectomy is a rare complication. Sexual intercourse is considered to be the main trigger of evisceration for premenopausal women. Vaginal evisceration occurs 2-5 months after hysterectomy. We report a case of vaginal evisceration after total laparoscopic hysterectomy, following sexual intercourse. Total laparoscopic hysterectomy may increase the risk of vaginal evisceration.

抄録全体を表示

We experienced a laparoscopic forceps' fracture and successfully retrieved the very small part. Laparoscopic forceps' fractures are known complications of laparoscopic surgery. To prevent this complication, forceps should be maintained in good condition. It is also important to know how to manage laparoscopic forceps' fractures quickly.

抄録全体を表示

Androgen insensitivity syndrome (AIS) results from a defect in the androgen receptor. Patients with AIS have a XY karyotype and a female phenotype. We present a patient with AIS and a serous gonadal cyst who underwent laparoscopic gonadectomy.
A 15-year-old phenotypic female was referred to our hospital due to primary amenorrhea. She was 162.5 cm in height and 63.0 kg in weight, with developed breasts (Tanner III) and no pubic hair. The gynecologic examination revealed a normal vulva and perineum. The distal vagina was 8 cm in length and ended blindly. A MRI revealed an absent uterus and ovaries and the presence of bilateral masses close to each external iliac vessel. A mass on the left side was cystic, with a diameter of 3.3 cm. A hormonal analysis was as follows: FSH, 12.0 mIU/mL; LH, 30.5 mIU/mL, E2, 36.25pg/mL, T, 10.12 ng/mL; and PRL, 23.9 ng/mL. The tumor markers were not elevated. The chromosome analysis revealed a normal 46,XY karyotype. We diagnosed complete androgen insensitivity syndrome (CAIS) and performed a laparoscopic gonadectomy. The histopathologic findings of the gonads revealed immature testes, and no signs of malignancy. After surgery, she received estrogen replacement therapy.
Estrogen from the gonads plays a role in developing feminine secondary sexual characteristics, thus gonadectomy is recommended after puberty in patients with AIS; laparoscopic gonadectomy has been shown to be a safe approach in such cases. In this case, we considered the possibility of malignant changes in the serous gonadal cyst, and a laparoscopic gonadectomy was performed before the completion of puberty.

抄録全体を表示

Bladder endometriosis is a relatively rare condition, representing < 1% of all endometriosis cases.
We report a case of bladder endometriosis in a 32-year-old woman who was successfully treated by laparoscopic surgery. She had a 6-month history of urinary tract symptoms, such as pain and urgency at micturition during menstruation. A MRI showed an irregular, 1.5-cm mass in the posterior wall of the bladder. She underwent a combined transurethral and laparoscopic partial cystectomy. Histopathologic examination confirmed bladder endometriosis. She remains symptom-free 9 months after resection of the bladder endometriosis. Considering the successful outcome, conservative laparoscopic surgery appears to be an effective method with a less invasive approach in the treatment of bladder endometriosis.

抄録全体を表示

Objective: Report of successful treatment of bladder endometriosis with laparoscopic extramucosal resection.
Case report: A 28-year-old woman presented with dysmenorrhea and mild urodynia. An 11 mm endometriotic nodule, blue in color with mucosal edema, was noted on the posterior wall of the bladder. There also was a 3 cm endometriotic cyst in the right ovary. Following pelvic adhesiolysis, laparoscopic excision of the lesions in the bladder wall and right ovary was performed. Resection of the bladder lesion was carried out preserving the bladder mucosa. The post-operative course was uneventful. Post-operatively, deinogest was administered for 1 year. The patient was in good health and had no urinary tract symptoms.
Conclusion: Laparoscopic resection of a bladder endometriotic lesion with preservation of the bladder mucosa may be a method of choice to treat bladder endometriosis, as well as to reduce the side effects which might be caused by operative interventions.

抄録全体を表示

Objective: The aim of this study was to evaluate the ovulatory performance and reproductive outcome after laparoscopic ovarian drilling using a harmonic scalpel in infertile women with clomiphene-resistant polycystic ovarian syndrome (PCOS).
Patients: Twenty clomiphene-resistant anovulatery women with PCOS underwent laparoscopic ovarian drilling between March 2005 and December 2006.
Results: After surgery, LH serum levels and the LH/FSH ratio showed statistically significant reductions, and ovulation occurred spontaneously in 70% (14/20) of the patients. The pregnancy rate was 50% (10/20) in < 1 year. Within 4 months postoperatively, 50% of all pregnancies had occurred.
Conclusion: Laparoscopic ovarian drilling is an effective treatment in women with clomiphene-resistant polycystic ovarian syndrome, yet without major complications associated with medical treatment, such as ovarian hyperstimulation syndrome and, plural gestations.

抄録全体を表示

Objectives: We used endoloops in the laparoscopic managements of interstitial pregnancy to investigate its usefulness.
Methods: Five cases of interstitial pregnancy (including 1 case of heterotopic interstitial pregnancy) were managed laparoscopically using the modified endoloop method as previously reported by Moon. Patient background, preoperative blood human chorionic gonadotropin (hCG) level, operation time, amount of blood loss and changes of postoperative hCG level were retrospectively reviewed. When interstitial pregnancy was identified, the fallopian tube and utero-ovarian ligament were cut after bipolar coagulation in the region proximal to the interstitial pregnancy. Then the cornual region was fastened by an endoloop to induce ischemia. Diluted vasopressin was injected into the cornual region, where further ligation was performed with the second endoloop, and the cornual region was incised. The second endoloop was gradually tightened simultaneously with the complete evacuation of the conceptus.
Results: Amount of blood loss was 350ml in one case and was not remarkable in other 4 cases. Operation time was 55-118 minutes. The mass size was 22-40mm. Preoperative blood hCG level was 11,000-20,100IU/l (except one case of heterotopic pregnancy). No case required an additional treatment for persistent ectopic pregnancy, but only one case showed the favorable decrease in postoperative hCG level.
Conclusion: Laparoscopic surgery for interstitial pregnancy using an endoloop was safe and bloodless. However, decrease of postoperative hCG level was not sufficient in many cases.

抄録全体を表示

Abstract: When a young woman with primary amenorrhea, complains about acute lower abdomen pain, we initially suspect hematometra by atresia-hymenalis, aplasia of vagina and others.
  We report an extremely rare case of ovarian tumor torsion with primary amenorrhea, initially diagnosed as hematometra, because it presented image finding closely resembling with hematometra.
Case Report: A 21-years-olds single woman was introduced to our department, to consult about acute lower abdominal pain. She had no menarche yet and no intercourse. She has no abnormal history such as severe weight control, hard exercise, anosmia and anorexia. In the internal examination, aplasia of vagina and atresia-hymenalis was ruled out. By the image diagnosis and her history as primary amenorrhea, we made the clinical diagnosis as hematometra in the cause of uterus cervical canal stenosis. We made dilatation of cervical canal and drainage of hematometra by trans- vaginal approach. However, bloody fluid was not aspirated and we decided on laparoscopy. Laparoscopy led to the definite diagnosis, which was the torsion of left ovarian tumor. We performed laparoscopic left salpingo- oophorectomy. The uterus was atrophic, but the right ovary was almost normal and it had many antral follicles. Pathological finding revealed that the left ovarian tumor consisted of serous cyst adenoma, and there were strong hemorrhage and hematoma in the cyst compartment and also ovarian cortex. After laparoscopy, hormonal examination was performed. The cause of primary amenorrhea was seemed to be pituitary amenorrhea. By the hormone replacement therapy by estrogen and progesterone, she had menarche.

抄録全体を表示

A 40-year-old woman suffered from severe bladder endometriosis involving the bladder trigone and left urethral orifice. Severe dysmenorrhea, lower urinary tract symptoms (pollakiurea and discomfort while urinating) were the chief complaints. The findings of magnetic resonance imaging (MRI) and transurethral resection of the tumor (TUR-BT) confirmed the diagnosis and revealed the extent of the lesion. Surgical resection of the lesion was not performed because of the difficulty anticipated for complete resection and the fear of affecting the bladder function after the resection. The administration of leuprolide acetate followed by genogest successfully reduced the tumor size and alleviated the symptoms for 14 months. Partial cystectomy is essential for complete remission and is indicated for patients who desire pregnancy. However, a high incidence of recurrence after resection of the tumor that involved the bladder fundus has been reported. Hence, it is important to individualize the treatment strategy for bladder endometriosis by accurately evaluating the location and the extent of the lesion.

抄録全体を表示

Herein we report a clinical case involving trans-cervical resection (TCR) of a submucosal myoma protruding into the cervix with a stalk connected to the uterine cavity through the internal os. Before performing TCR, there was concern that leakage of fluid from the cervix would obscure the operative field. In this case, we chose TCR and successfully treated the submucosal myoma protruding into the cervix. TCR is an extremely effective procedure in terms of reliable homeostasis and diminishing the remaining tumor and stalk.

抄録全体を表示

Background: We examined the safety of hysteroscopic resection of sessile submucous myoma over 5cm diameter.
Material and Methods: Hysteroscopic resection was performed in 32 women from October, 2006 to April, 2008. (group A: endometrial polyps in 15, group B:under 5cm diameter sessile submucous myoma in 13, group C: over 5cm diameter sessile submucous myoma in 4) Modified resectoscopic technique was used. Firstly we cut the endometrial mucosa that covers the myoma. After resected connecting tissue between myoma and normal muscle, the myoma was excised followed by ring forceps extraction. For each patient, pre- and postoperative hemoglobin (hgb) change, operating time, 3% D-sorbitol solution volume were recorded.
Results: One-step hysteroscopic myomectomy performed in all cases. The difference between the preoperative and postoperative Hgb was -0.33±0.9 g/dl (A), -1.18±0.5 (B), -2.25±0.3 (C). It was significantly change (p<0.05 Mann-Whitney U).
The operating time was significantly shorter in group B (41.9±28 min) than in group C (95.0±26 min p<0.05 ). D-sorbitol solution volume was significantly less in group B (7003±2060 ml) more than group C (13625±4643 ml p<0.05).
Conclusion: We should be operated on with care about bleeding and absorption of D-sorbitol solution in hysteroscopic resection of large myoma.

抄録全体を表示

We present a case of a 65-year-old woman with chemical panperitonitis following a rupture of the ovarian dermoid cyst, which was successfully treated through laparoscopic surgery. She was referred to our hospital with a large pelvic mass demonstrated in CT scan. Prior to the referral she had complaints of a decrease in urine amount, distended abdomen and high fever.Laboratory data revealed a high inflammatory reaction (WBC count 9100/μl, CRP 20.01mg/dl) and elevated tumor markers (CA125: 47.4U/ml, CA19-9: >12000U/ml). It was confirmed by UST that there was a pelvic cystic mass in the left lower quadrant with a large amount of ascites. MRI findings showed the pelvic cystic tumor to have characteristic features suggestive of the benign ovarian dermoid cyst. It was suggested that the left ovarian dermoid cyst was exacerbated by pelvic inflammatory disease. After the admission she was treated with intravenous antibiotics. The inflammatory condition improved after the conservative therapy. We decided to perform a laparoscopic surgery to remove the mass in 60 days after the appearance of the first symptoms. Using a 9^th intercostal space approach with 3mm scope, it was shown that there were various dense adhesions between the intestines and the parietal peritoneum. Proceeding catiously with adhesiolysis, the pelvic cavity was finally outlined. Left adnexectomy was performed and multiple peritoneal drainages were inserted into the peritoneal cavities. From the laparoscopic findings and the histological examination, the final diagnosis was chemical panperitonitis following a spontaneous rupture of the ovarian dermoid cyst. We reported a successful laparoscopic intervention in the chemical peritonitis, even though it involved a great amount of difficulties in the operative procedures.

抄録全体を表示

Objective: To determine the pregnancy rate after laparoscopic surgery on infertile women with endometriosis.
Design: The pregnancy outcomes of 379 infertile women with endometriosis after laparoscopic surgery was followed for 9 months and retrospectively analyzed.
Results: One hundred sixty-two patients (42.7%) conceived, as follows: spontaneous, 34; timed intercourse, 47; intrauterine insemination, 26; and assisted reproductive techniques (ART), 54. The cumulative pregnancy rate in patients with stage IV endometriosis (30.6%) was lower than patients with stage I endometriosis (43.1%) 18 months after laparoscopy. The cumulative pregnancy rate was 30.3% in all patients, and 23.2% in patients excluding ART pregnancies, 12 months after laparoscopy. Seventy percent of pregnant women conceived within 12 months. The pregnancy rate within 12 months with ART was 50%, whereas the pregnancy rate without ART technology was 80%-90%.
Conclusion: Our findings suggest that treatment, such as observation, timed intercourse, and intrauterine insemination, should be performed for infertile women with endometriosis up to 12 months after laparoscopic surgery.

抄録全体を表示

Objectives: We present our initial experience in single-port laparoscopic salpingectomy for the treatment of tubal pregnancy. By using an abdominal wall lifting system, the technique is gasless and an open top lap-protector can be used.
Method: Between 2002 and 2008,175 women with ectopic pregnancies underwent laparoscopic surgery or laparotomy at Saiseikai Utsunomiya Hospital. One hundred fifty patients who had tubal pregnancies underwent salpingectomy by laparoscopy or conventional laparotomy. We began gasless three-port laparoscopic surgery in 2002, and reduced the number of ports to two in 2006. In 2007, we began to perform single-port laparoscopic surgery. For gasless laparoscopic surgery, we make an infraumbilical incision, 1.5-2.0 cm in length, where the abdominal wall lifting system is inserted. After raising the abdominal wall, the scope is introduced through the same incision with a sheath. For single-port laparoscopic surgery, we change the sheath to an open top lap-protector, through which we insert not only a 5 mm scope, but also Ligasure V and other laparoscopic instruments. Using this single-port system, single-port laparoscopic salpingectomy was performed.
Results: Ninety-five patients underwent three-port laparoscopic salpingectomies, and the mean operating time was 76±25 min. Sixteen patients underwent two-port laparoscopic salpingectomies, and the mean operating time was 79±32 min. Eleven patients underwent single-port laparoscopic salpingectomies, and the mean operating time was 65±19 min. Using this new method, the operating time was comparable to that of standard laparoscopic methods.
Conclusion: Our results showed that single-port laparoscopic salpingectomy is a feasible and safe technique.

抄録全体を表示

  It is important to remove endometrial polyps, which are well-known as a cause of implantation failure, from infertile female patients. Transcervical resection (TCR) is a treatment modality developed for endometrial polyps. We report a case involving a female with infertility due to an endometrial polyp which was shown to be an endometrial stromal sarcoma (low grade) after TCR.
  The patient was a 30-year-old nulligravida. She had no significant medical history, and had been married for 13 months. Before seeking evaluation at Fukushima Medical University Hospital, she underwent a myomectomy under laparotomy at another hospital. According to the pathology report, the fibroid was a cellular myoma with no evidence of malignancy. However, an endometrial polypoid lesion was noted during hysterosalpingography after the follow-up examination. On transvaginal ultrasonography, the solitary polyp was 22 mm in diameter with a cystic component. Before surgery, she received GnRH analog treatment for 1 month. Based on the resected specimen, the polyp was highly suspected to be an endometrial stromal sarcoma, therefore she was informed that a hysterectomy with bilateral oophorectomy and pelvic lymphadenectomy was recommended for radical treatment. Two months later, the surgery was performed, and it was finally diagnosed that the uterine fibroma was composed of an endometrial stromal sarcoma (low grade). She was treated with oral medroxyprogesterone acetate without evidence of recurrence.

抄録全体を表示

Intra-operative hypothermia caused by a pneumoperitoneum is common in patients during laparoscopic surgery. Hypothermia is known to cause many adverse complications. The purpose of this study was to evaluate the factors influencing hypothermia. Core temperatures during surgery were recorded in patients undergoing laparoscopic surgery (n=158). Forty-seven and 51 patients were insufflated with heated CO₂ gas and humidified gas, respectively. The room temperature was kept at 25°C, and warming blankets were placed under the patients. Bottles of infusate and saline (for irrigation) were kept at 37°C. The parameters for multiple regression analysis included: age, BMI, duration of surgery, initial body temperature, and the mean decrease in temperature (maximal decrease and the decrease at the end of surgery) in 3 groups (control [n= 60], warmed gas [n= 47], humidified gas [n= 51]) ; were analyzed to evaluate the effectiveness of warm and humidified gas; there was no significant difference in those parameters influencing body temperature. Multiple regression analysis showed that the factors had a significant correlation with the decrease in BMI, duration of surgery, initial body temperature, and humidified gas. The mean maximal decrease in temperature in the control, warmed gas, and humidified gas groups was 1.03 °C, 0.90 °C, and 0.75°C, respectively; here was no statistical significance between the groups. The mean decrease in temperature at the end of surgery in the control, warmed gas, and humidified gas groups was 0.93 °C, 0.84 °C, and 0.49°C, respectively; there was statistical significance between the humidified gas group and the other groups.

抄録全体を表示

Objectives: The purpose of this study was to determine the feasibility and radicality of endoscopic radical hysterectomy (ERH) and endoscopic modified radical hysterectomy (EmRH) combined with pelvic lymphadenectomy (ELND) in invasive cervical cancer patients.
Methods: Five patients with invasive cervical cancer underwent ERH or EmRH between May 2003 and March 2007 at Hokkaido University Hospital. Two patients with stage I a adenocarcinoma underwent an EmRH, and two patients with stage I b1 and one patient with stage II a underwent an ERH. All patients gave their informed consent to this experimental procedure before surgery.
Results: The median age of patients was 39 years (range, 33-45 years), and the median body mass index was 20.2 kg/m² (range, 18.5-23.7 kg/m²). The maximum tumor diameter was 20mm in 1 patient, and ≤10mm in 4 patients. The pathologic subtype was squamous cell carcinoma in 2 patients, and adenocarcinoma in 3 patients. The median operative time was 734 min (range, 583-974 min), the median blood loss was 890 ml(range, 280-2650 ml), the median number of lymph nodes removed was 77 (range, 47-103), and the median length of vaginal cuff removed was 20mm(range, 10-25mm). The median duration of hospitalization post-operatively was 16 days (range, 13-23 days). A post-surgical infection occurred in one patient, but no severe complications were noted. There were no relapses after a mean follow-up period of 31.8 months (range, 15-71 months).
Conclusions: An ERH or EmRH with ELND is feasible and might be beneficial for early invasive cervical cancer.

抄録全体を表示

Laparoscopic adenomyomectomies are performed in women with localized uterine adenomyosis with desired fertility. Both monopolar electric knives and Harmonic Scalpels^® have been widely used in laparoscopic procedures; however, resection is not always easy, because both adenomyomatic and normal myometrial tissue develop heat degeneration with these devices, and the interface between abnormal and normal tissue is unclear. Here we report a successful adenomyomectomy using a cold knife (Endoscalpel^®) following use of a Harmonic Scalpel^®. The interface became clearer and the adenomyomatic lesion was resected.

抄録全体を表示

Objective: To evaluate risk factors which are associated with recurrence of endometriotic cysts after cystectomy.
Method: Fifty-seven patients who had a minimum of 6 months of observation after cystectomies for endometriotic cyst were studied retrospectively. Recurrence was defined as the presence of an endometriotic cyst > 2 cm in size on transvaginal ultrasonogram during the post-operative follow-up period. We evaluated nine variables (age, laparoscopic surgery/laparotomy, size of the largest cyst, laterality, findings of transvaginal ultrasonogram, serum CA-125 levels, revised American Society for Reproductive Medicine [r-ASRM] classification, and pre- and post-operative medical treatment) to assess the effects on the recurrence using logistic regression analysis.
Result: The overall rate of recurrence was 17.5% (10/57). The cumulative rate of recurrence over 60 months was 32.1%. Laparoscopic treatment had a higher recurrence rate than laparotomy (p<0.05).The statistically significant factor that was associated with a higher recurrence rate was pre-operative medical treatment (p=0.02).
Conclusion: Pre-operative medical treatment of endometriotic cysts is associated with a higher recurrence rate after cystectomy.

抄録全体を表示

In general gynecological laparoscopic surgery using multi port technique, three trocars were placed through three separate skin incisions, for two accessory ports in addition to a monitoring port. As lower degree of invasiveness is considered to be desirable for laparoscopic surgery, we underwent Single Port Access (SPA™) utilizing a single incision at the umbilicus with multi channel port. Three 5mm trocars were all inserted thorough separate sites of the single skin incision. A 30-degree 5 mm scope was inserted through the central trocar. Utilization of a clear central long trocar allows visualization of inserting process of the lateral two trocars into the abdomen. Two additional 5 mm trocars were placed thorough separate facial entry points to make triangle port formation. The tumors were extracted with an Endo bag device by exchanging the central 5 mm trocar for a 12 mm trocar and inserting a retrieval bag. This technique allows for the entire procedure such as salpingo oohorectomy, ovarian tumor cystectomy and the other surgery, to be performed in the standard fashion similar to the multi port technique. The use of Single Port Access (SPA™) for surgery was useful for gynecologic laparoscopic surgery and improved cosmetics with only one inconspicuous incision within the umbilicus.

抄録全体を表示

  A hydrosalpinx is a distally blocked fallopian tube filled with fluid. A hydrosalpinx is known to cause sterility and torsion. The most common causes of hydrosalpinx are undiagnosed or untreated sexually transmitted diseases, like Chlamydia. The blocked tube may become substantially distended, giving the tube a characteristic sausage-like shape. The diagnosis of hydrosalpinx can be made by ultrasound, CT, and MRI.
  We studied 30 cases of hydrosalpinx between 2000 and 2007 in our facilities. Some patients with a hydrosalpinx had pelvic pain, while others were asymptomatic. Patients who had no symptoms were diagnosed while evaluating ovarian cyst. The typical example of a hydrosalpinx was easy to be diagnosed by the ultrasound; however, there were some cases in which it was difficult to discriminate a hydrosalpinx from an ovarian cyst. In such cases, 3D construction with hydrography that emphasizes water in MRI ( T2 emphasis image ) was extremely useful for discriminating a hydrosalpinx from an ovarian cyst. MR-salpingography provides the most definitive diagnosis of hydrosalpinx. MR-salpingography does not cost extra, is non-invasive, and does not need contrast medium. Moreover, the overall image was captured easily by observation from many fields. Torsion was diagnosed from the images in cases who were admitted before surgery.
  Diagnostic imaging is useful for the diagnosis of a hydrosalpinx. Specifically 3D construction with hydrography in MRI (MR-salpingography) is useful to confirm the diagnosis.

抄録全体を表示

Objective: Bilateral hydrosalpinx is an absolute cause of female infertility. It has been reported that the pregnancy rates following assisted reproductive technology (ART) in such patients is low. Surgical treatment for hydrosalpinx, such as salpingostomy, salpingectomy, and tuboplasty for proximal tubal occlusion, have been recommended prior treatment to ART. Salpingostomy is the only treatment following which one can expect a spontaneous pregnancy. The objective of this study was to evaluate the efficacy of laparoscopic salpingostomy for infertile women with bilateral hydrosalpinx.
Methods: Thirty infertile patients with bilateral hydrosalpinx underwent laparoscopic bilateral salpingostomy. The relationship between the prognosis following salpingostomy and the appearance of the hydrosalpinx (peritubal adhesions, size, and tubal epithelium of the ampulla) was examined.
Results: The pregnancy rate without ART treatment following laparoscopic salpingostomy was 37% (11 of 30). The abortion rate was 15% (2 of 11). There were no ectopic pregnancies in this study population. Nine of 11 pregnancy cases became pregnant within 2 years following salpingostomy. Eight of the nine cases had a well-preserved tubal epithelium of the ampulla on at least one side. There was no significant difference in the pregnancy rate by the overall appearance of the hydrosalpinx; however, there was a significant difference in the state of the tubal epithelium of the ampulla when pregnancies occurred within 2 years following salpingostomy.
Conclusion: Laparoscopic salpingostomy for bilateral hydrosalpinx seems to be effective, according to patients. The prognosis appears to depend on the tubal epithelium of the ampulla.

抄録全体を表示

Objective: To evaluate the feasibility of laparoscopic adnexectomy as the first step in laparoscopic training.
Design: Retrospective study.
Setting: Koshigaya Municipal Hospital.
Patient: Forty-three patients with ovarian cysts. Fourteen patients underwent surgery by certified laparoscopists, and twenty-nine patients underwent surgery by residents.
Intervention: Laparoscopic adnexectomies were subdivided into four levels based on the energy source, ligation, and suture technique.
Result: The mean operating time was 58.5±3.8 minutes in the laparoscopist group and 72.6±3.5 minutes in the resident group (P<0.05). Blood loss was not significantly different between the two groups. Among the four different levels of adnexectomies, the operating times and blood loss were not significantly different.
Conclusion: We conclude that residents are able to acquire laparoscopic surgical skills in a step-by-step manner at our institution using adnexectomy as a standard procedure.

抄録全体を表示