Robotic-assisted surgery offers a stable high-resolution 3-dimensional perspective, wrist-like mobility of therobotic arms with motion scaling and tremor control. These functions compensate the disadvantages of conventional laparoscopic surgery and improve ergonomics with a shortened learning curve. In field of gynecology, robotassisted surgery was initially applied to laparoscopic tubal anastomosis at Cleveland Clinic in 1998. The procedures have expanded to cystectomy, oophorectomy, simple and radical hysterectomy, myomectomy, pelvic andparaaortic lymphadenectomy, removal of deep infiltrating endometriosis, and the like. In Japan the first robotassisted hysterectomy was performed at Tokyo Medical University in 2009. In 2018, robot-assisted laparoscopichysterectomy for benign disease and early-stage endometrial cancer was covered by insurance. In 2020, robotic sacrocolpopexy was added to insurance coverage. In our department, we started robot-assisted laparoscopichysterectomy with bilateral salpingo-oophorectomy for early-stage endometrial cancer in 2019. This operation isperformed in compliance with the guidelines of the Japanese Society of Obstetrics and Gynecology, and all patients need to be registered in the National Clinical Database (NCD). Although the da Vinci surgical system fromIntuitive Surgical has long dominated the field of robot-assisted surgery, with the expiration of the core patentsof Intuitive Surgical, multiple robot-assisted surgical systems with costly and functional effectiveness have beenintroduced to market. The robot-assisted surgical system is also applied to vaginal natural orifice transluminalendoscopic surgery.

Metabolomic analysis employing mass spectrometry has emerged as a prominent method for comprehensivelystudying the types, quantities, and dynamics of metabolites, garnering significant attention as a burgeoning omicsfield. This article elucidates the fundamental principles of mass spectrometry utilized in metabolomics, focusingon GC‒MS, LC‒MS, and CE-MS, prominent analytical techniques distinguished by their ionization methods,separation approaches, and chromatography. It outlines the metabolomics workflow from sample collection andpreparation to data analysis. Additionally, our illustrative case study demonstrating the application of metabolomics in discerning metabolic disparities among organs intended for transplantation is presented.

Catheter ablation is a widely accepted therapy for atrial fibrillation (AF), of which stroke is a major complication. Stroke after catheter ablation has been reported in numerous studies in the acute phase and in the chronic phase. A 66-year-old man with drug refractory paroxysmal AF underwent catheter ablation. The patient was followed as an outpatient without any complications and no recurrence of AF, and transthoracic echocardiography(TTE) revealed no foreign objects. Fourteen months later, the patient was diagnosed with cerebral infarction. Transesophageal echocardiography (TEE) revealed an ovoid mass on the anterior aspect of the right superior pulmonary vein atrium where the previous ablation was performed. The patient received appropriate anticoagulation, and the mechanism of thrombus formation is uncertain. We report a very rare case in which left atrial thrombus formation required surgical treatment 14 months after cryoballoon ablation. Careful follow-up with multiple modalities is necessary for the detection and diagnosis of chronic phase thrombus formation.