Study objective:In order to reduce the risk of vaginal recurrence, we have chosen total laparoscopic modified radical hysterectomy instead of extrafascial hysterectomy in the treatment of endometrial cancer. The aim of this study was to assess the safety of this method.Design:Retrospective study of gynecological patients.Setting:Yokohama City University Medical Center, Yokohama, Japan.Patients:Forty-nine patients who underwent total laparoscopic modified radical hysterectomy for the treatment of endometrial cancer at our hospital between December 2011 and September 2015.Interventions:Total laparoscopic modified radical hysterectomy + bilateral salpingo-oophorectomy (n = 20), total laparoscopic modified radical hysterectomy + bilateral salpingo-oophorectomy + pelvic lymphadenectomy (n = 18), or total laparoscopic modified radical hysterectomy + bilateral salpingo-oophorectomy + pelvic and para-aortic lymphadenectomy (n = 11).Measurements and Main Results:The surgical outcomes were analyzed and compared to previous reports. The median operative time was 204 minutes (range, 99–504 minutes) and the median intraoperative blood loss was 150 mL (range, 0–680 mL). No patients needed a blood transfusion, conversion to laparotomy, or reoperation. Intra- and postoperative complications were observed in three patients and nine patients, respectively. The amount of blood loss and the incidence of complications in our study were almost identical to previous reports of laparoscopic hysterectomy. The operative time in our study was equivalent to previous reports of total laparoscopic modified radical hysterectomy.Conclusion:Total laparoscopic modified radical hysterectomy is safe and feasible for the treatment of early stage endometrial cancer. This procedure can be an alternative to total laparoscopic hysterectomy, especially when the uterus must be removed completely.

Study Objectives:The aim of this study is to evaluate the effects of vaginal estriol therapy in total laparoscopic hysterectomy (TLH) with gonadotropin-releasing hormone agonist (GnRH-a) treatment.Design:Retrospective analysis.Design Classification:Canadian Task Force classification II-2.Settings:Department of Gynecology, Yokohama City University Medical Center, Japan.Methods:We retrospectively investigated 50 fibroid cases that had TLH with preoperative GnRH-a treatment and compared the surgical outcome with or without vaginal estriol use (1mg). Estriol was used administered for two weeks before TLH.Measurements and Main Results:A total of 12 patients (27%) received vaginal estriol (1 mg) for 14 days before TLH. As a result of vaginal estriol treatment, there were no group differences in uterus size reduction with GnRH-a treatment (22% vs. 15%, P = 0.20), uterine removal time through the vagina (12.5 min vs. 18.5 min, P = 0.18), rate of vaginal dehiscence (3% vs. 0%, P = 0.76) or in the rate of perineal laceration (33% vs. 34%, P = 0.55).Conclusion:The use of vaginal estriol treatment before TLH with GnRH-a therapy did not improve surgical outcomes.

Fallopian tube torsion caused by a paraovarian or paratubal cyst during pregnancy is rare. A 30 year old woman (gravida 2, para 1) was referred to our hospital with acute-onset right abdominal pain and a coinciding cyst measuring 5cm detected by ultrasonography at 37 gestational weeks. Although ovarian torsion was suspected, her symptoms were mild, and in consideration of operative difficulty, we decided to postpone laparoscopic management until after delivery. At 38 gestational weeks, she delivered a male infant (2810g) after induction. Her symptoms continued and laparoscopic surgery was performed at 6 days after delivery, which revealed right fallopian tube torsion due to a paraovarian cyst. The right ovary was intact. The right fallopian tube and the paraovarian cyst was necrotized, adhered to the peripheral peritoneum, and was resected laparoscopically with relative ease. Her postoperative course was uneventful.

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