Recently, there have been case reports of ovarian torsion occurring after total laparoscopic hysterectomy (TLH). At our institution, TLH is performed using a lateral approach, which results in a wide opening of the retroperitoneum, increasing ovarian mobility. Increased ovarian mobility may elevate the risk of postoperative ovarian torsion, and although methods for preventing torsion are needed, there is limited evidence supporting preventive measures. In our practice, we perform ovarian fixation to the retroperitoneum using a sealing device during surgery, and here we report the results of this fixation method. Ovarian fixation is achieved by coagulating the ovarian ligament to the retroperitoneum using an Erbe BiClamp® (bipolar coagulation forceps), typically employed for hemostasis during surgery. Between April and July 2024, 12 cases of ovarian fixation were performed during TLH using a BiClamp, and 10 of the 12 cases (83%) demonstrated visible ovaries on follow-up ultrasound post-surgery. Two cases showed successful fixation, with consistent ovarian observation at both immediate postoperative and follow-up transvaginal ultrasound three months later. The fixation is thus considered to persist reliably over time. Successful fixation requires collaboration with the assistant to grasp the ovarian ligament and retroperitoneum, coagulating multiple sites. Care must be taken to avoid thermal damage to blood vessels or the ovaries by elevating the tissue and coagulating the membrane only. No patients in this study reported ovarian loss symptoms postoperatively. The fixation technique we employed is simple, cost-effective, and may contribute to preventing torsion.

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Objective : Although high-dose medroxyprogesterone acetate (MPA) has been used as a fertility-preserving therapy for early stage, G1 endometrioid carcinoma and atypical endometrial hyperplasia (AEH), the therapy was associated with a high recurrence rate. However, there is little evidence regarding the usefulness of readministration of MPA for intrauterine recurrence, therefore, we investigated its effectiveness and safety.
Methods : We retrospectively analyzed 29 patients of endometrioid carcinoma G1 and AEH who underwent high-dose MPA therapy from 1998 to 2020 at Shinshu University hospital.
Results : Of a total 29 patients, eight were endometrioid carcinoma G1, and 21 were AEH. The median age at the start of the first MPA therapy was 34 years (25-46 years), and the complete response (CR) rate was 88％ for endometrioid carcinoma G1 and 95％ for AEH. The recurrence rate was 78％ (21 of 27 CR patients). Eight patients (endometrioid carcinoma G1 : two patients, AEH : six patients) underwent the re-administration of MPA, and the CR rate was 100％. A total hysterectomy was finally performed on 18 patients, all patients are alive and disease-free. Eight of 12 patients (67％) who attempted pregnancy after high-dose MPA therapy achieved pregnancy, and six patients (50％) delivered a healthy full-term live birth. Only after MPA re-administration, the rate was 50％.
Conclusion : Although this study was conducted in a small number of cases, the CR rate with MPA readministration was high, and several cases achieved live births, therefore, it was considered to be a treatment option.

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