Objectives: This study was to evaluate the effectiveness of antibiotic prophylaxis in clean laparoscopic surgery for benign ovarian tumor.
Method: 84 patients underwent clean laparoscopic surgery including cystectomy and salpingo-oophorectomy at Osaka Rosai hospital from Jan 2004 to Jun 2006, and were allocated to two groups. One group received cefazolin 1g single dose as prophylactic antibiotics just before the initiation of operation (42 patients) and another group did not received it (42 patients) . We investigated the incidence of surgical site infection (SSI) between two groups prospectively based on CDC guideline.
Result: Age, BMI, preoperative serum albumin level, preoperative hospital stay, and duration of operation, postoperative glucose level did not differ significantly between two groups. 9.5% (4 patients) of women in the antibiotics group and 11.6% (5 patients) of women in the control group diagnosed Superficial incisional SSI. The incidence of Deep incisional SSI was 0% in both groups and the incidence of Organ/Space SSI was 4.8% (2 patients) and 2.4% (1 patient) respectively. The incidence of Superficial incisional, Deep incisional, and Organ/Space SSI did not differ significantly between two groups. No side effects such as an allergic reaction were observed.
Conclusion: In our setting, the administration of a single dose of 1g cefazolin before clean laparoscopic surgery did not reduce the incidence of SSI. Antibiotic prophylaxis has no benefit in the patients undergoing clean laparoscopic surgery including cystectomy and salpingo-oophorectomy.

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Background: Submucosal myoma has been treated with hysteroscopic transcervical resection (TCR) . However, in cases of unstalked submucosal myoma over 3cm in diameter, TCR could lead to not only extended operation time but also extensive thermal damage on endometrium by electrocoagulation. In this study, we validated the feasibility and utility of total Laparoscopic approach for submucosal myoma treatment.
Materials and Methods: Total laparoscopic myomectomy (TLM) was performed on 12 women with submucosal myoma. Our TLM procedure was as follows: a balloon catheter was detained in the uterine cavity to evaluate the degree of submucosal projection by sonohysterography. Culdotomy was performed to set acrylic vaginal pipe into intraperitoneal cavity as a larger access port. After intramyometrial injection of vasopressin, a transverse incision was made to extract myomas. As myomectomy progressed, endometrium filled with indigocarmine through a detained balloon catheter appeared transparent-blue bulge, which helped easy recognition of endometrial injury. Uterine wall was sutured layer by layer without tucking the endometrium into myometrium. The enucleated nodules were removed via a vaginal pipe.
Results: The median size of dominant submucosal myomas was 5cm, the median blood loss was 120ml and the median operating time was 162 minutes. There was no correlation between the degree of submucosal projection and endometrial defect. Minimal endometrial damage was observed and one of 3 infertile patients was pregnant after surgery.
Conclusion: TLM was feasible in the cases of submucosal myoma as well as intramural and subserosal myomas.

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Objective: Laparoscopic ovarian cystectomy is going to be routine technique even for pregnant women because of providing minimal invasion and cosmetic advantage. We summarized 25 cases of laparoscopic surgery and 13 cases of laparotomy for ovarian tumor in pregnant women.
Design: Clinical data from 38 cases of ovarian tumor with pregnant surgically treated in our institute were retrospectively analyzed. Surgical treatment was applied when ovarian tumor diameter was more than 60mm or patient had symptoms. The patients with either high level of serum tumor marker or thickened cyst wall or papillary region by ultrasonograph were excluded from endoscopic surgery.
Results: The mean gestational week when provided surgical treatment was 14.0 weeks. The mean diameter of tumor was 86.7mm. Abdominal wall lifting method using Kirschner wire and extra-corporal cystectomy were applied in all of laparoscopic surgery. The mean duration of laparoscopic surgery was 112 min. that is significantly longer than laparotomy (70min, p<0.05) . The mean period of hospitalization for laparoscopic surgery was 8.4 days, that is significantly shorter than laparotomy (10.7 days, p<0.05) . Eighteen cases of laparoscopic surgery obtained intact babies at term. One case was fetal hydrops and fall into stillborn at 18 gestational week. One case was premature delivery at 27 weeks. Any relationship between events and laparoscopic surgery were not found in both cases.
Conclusion: We closely confirmed that the laparoscopic surgery for ovarian cyst is useful and safe even in pregnant women.

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The results of laparoscopically associated vaginal hysterectomy (LAVH) in our hospital shows that removed uterus of over 800g in weight produces significantly raised operative blood loss. Removed uterine weight is an important decision factor for hysterectomy. Therefore, we conducted this study to achieve a more reliable preoperative uterine weight estimation using MRI.
We compared the results from two methods of estimation for 135 total hysterectomy cases: Method A _??_ estimation based on three parameters including the distance from uterine apex to external os using preoperative MRI; method B -estimation based on the sum of products of diameters in three directions of the biggest three myoma nodes. The equation of regression of the removed uterine weight (y) obtained by method A is y=0.503x-35.9 (x=a×b×c) and that obtained by method B (y) is, y=0.604x+249 (x=sum of a×b×c) from method B.Both equations of regression have significant correlations between estimated uterine weight and removed uterine weight.
These equations to estimate uterine weight will contribute to the decision of approach

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OBJECTIVE: The aim of this study was to assess the efficacy of laparoscopic resection of pelvic peritoneum in addition to conventional laparoscopic uterosacral nerve ablation (LUNA) procedure on the relief of treatment refractory pelvic pain in patients without preoperative diagnosis of endometriosis.
METHODS: We performed laparoscopic peritonectomy combined with LUNA in 13 patients who had not been diagnosed as endometriosis. Intraoperative findings were re-assessed by videos recorded during surgery. Peritoneal specimens were pathologically reviewed. Postoperative details on dysmenorrhoea, chronic pelvic pain (CPP), dyspareunia and dyschezia were evaluated using an interview-based questionnaire.
RESULTS: Five out of all 13 cases were diagnosed as endometriosis post operatively. In 8 cases without endometriosis, 4 had peritoneal adhesion, 3 had suspicion of infection and 3 without any abnormal findings. The pathological observations showed scar and fibrosis of peritoneum in 4 cases, and neutrophil and eosinophil accumulation around the endothelium of vessels in 4 cases, suggesting localized inflammation. There was significant reduction in dysmenorrhea and CPP at 12 months follow up. The pain outcomes associated with intercourse or evacuation were reduced post operatively, either. There were no particular intra or postoperative complications observed. Three women needed post operative treatment with NSAIDs and/or oral contraceptives.
CONCLUSION: Laparoscopic peritonectomy combined with LUNA seems safe and effective procedure to alleviate pelvic pain in patients without preoperative diagnosis of endometriosis.

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