AimOpen myomectomy (OM) was previously frequently performed; however, laparoscopic myomectomy (LM) has recently become more common. Nevertheless, myoma can recur after both LM and OM. In this study, we report our retrospective investigation of myoma recurrence by comparing LM and OM.MethodsA total of 474 patients underwent LM and 279 patients underwent OM. The patients were followed‐up postoperatively from six months to eight years. Recurrence was confirmed when a myoma with a diameter of ≥ 1 cm was detected. Post‐LM, post‐OM and cumulative recurrence rates were investigated, and a Cox hazard test was performed.ResultsThe cumulative recurrence rates between the two groups were 76.2% (LM) vs. 63.4% (OM) at eight years postoperatively. A log‐rank test revealed a significant difference between the two groups. Cox hazard testing revealed that LM, a larger number of enucleated myoma masses and the absence of postoperative gestation significantly contributed to the postoperative recurrence rate.ConclusionsLM yielded a higher recurrence rate than OM, likely a result of manual myoma removal in OM, which is a more exhaustive extraction of smaller myoma masses than performed in LM. In other words, fewer residual myoma masses after OM contribute to a lower postoperative recurrence rate.

Cervical elastography might be an objective method for evaluating cervical ripening during pregnancy, but its usefulness has not been fully investigated. We examined the significance of cervical elastography in the last trimester of pregnancy. Cervical elastography was performed at weekly checkups after 36 weeks of gestation in 238 cases delivered at our hospital from 2017 to 2018. The correlation with the onset time of natural labor, which is an index for judging maternal delivery preparation status, was examined. A total of 765 examinations were conducted, and cervical stiffness determined by cervical elastography was positively correlated with the Bishop score (r = 0.46, p < 0.0001). When examined separately for each week, only the examinations performed at 39 weeks were associated with the onset of spontaneous labor up to 7 days later (p = 0.0004). Furthermore, when stratified and analyzed by the Bishop score at 39 weeks of gestation, cervical elastography was associated with the occurrence of spontaneous labor pain for up to seven days in the groups with Bishop scores of 3–5 and 6–8 (p = 0.0007 and p = 0.03, respectively). In conclusion, cervical elastography at 39 weeks of pregnancy is useful for judging the delivery time.

Background Laparoscopic surgery has been described as a minimally invasive surgery. The purpose of this study is to clarify its minimal invasive features using a patient questionnaire on the postoperative quality of life (QOL) over various time periods following either laparoscopic hysterectomy (LH) or abdominal hysterectomy (AH) and to compare the results. Methods This study enrolled 28 patients who underwent total hysterectomy for uterine fibroids in 2012 (14 AH cases and 24 LH cases) were enrolled in this study. The 36-Item Short Form Survey (SF-36) questionnaire was completed on postsurgical day 3; weeks 1, 2, and 4; and month 6. The results were compared between the two groups. Results Patients who underwent LH scored significantly higher on physical functioning on postoperative day 3 and week 2; physical role and bodily pain on day 3 and week 1; general health on postoperative day 3, weeks 1, 2, and 4, and month 6; social functioning on day 3; and emotional role on day 3 and week 1. No significant differences were found between vitality and mental health at any time point or in the categories above at any other time point. Conclusions Postoperative QOL in LH cases was improved on day 3 and week 1; however, no significant differences between the LH and AH groups were found in most categories at week 4 and month 6. LH leads to superior short-term QOL early in the postoperative period relative to AH.

Background A uterine manipulator cannot be used to elevate the ovary in benign ovarian surgery during pregnancy. This report describes our method of elevation of the ovary using a metreurynter with the success rate of the procedure and a comparison of surgical results and pregnancy outcomes between the successful and unsuccessful cases. Methods Between August 2003 and February 2020, 11 pregnant patients with a tumor found sunk in the Cul-de-sac underwent laparoscopic cystectomy for a benign ovarian cyst with a metreurynter. The surgical results, success and failure of the elevation by a metreurynter, pregnancy outcomes, and fetal status at delivery were evaluated. Results Elevation of ovarian tumors with a metreurynter was successful in nine cases. However, it was unsuccessful in the remaining two cases wherein the ovary was lifted with forceps while the uterus was in a compressed state. The operative time was also longer in these cases. The pregnancy prognosis, however, was good for both, successful and unsuccessful cases. Conclusions The metreurynter is an inexpensive and practical obstetric device, and its optimal use allows the performance of a procedure with minimal burden on a pregnant uterus. Therefore, we recommend the appropriate use of this method to enable effective laparoscopic cystectomy of ovarian tumors during pregnancy.

To describe operative complications of patients with a body mass index (BMI) < 35 to those of patients with BMI ≥ 35 who underwent robotic-assisted hysterectomy by a single surgeon. Design: A retrospective chart review. Setting: Two academic community hospitals. Patients: All patients with endometrial cancer who underwent roboticassisted hysterectomy at two community hospitals by a single surgeon from January 2012 to December 2015. Measurements and Main Results: 163 women ages 29 to 95 were included in this study. 72 (44%) were found to have a BMI ≥ 35 and 91 (56%) had a BMI < 35. Of the preoperative risk factors, only cardiovascular disease was found to be significantly different between the groups where 62 (86.1%)of patients with a BMI ≥ 35 were found to have the risk factor, compared to 62 (68.1%) of those with a BMI < 35 (p-value = .01). Median operative robotic console time was 118 minutes in patients with a BMI ≥ 35 compared to 147 minutes in those with BMI < 35 (p-value = .048) Additionally, 80(87.9%) patients in the BMI < 35 group underwent lymph node dissection, while 54 (75%) underwent lymph node dissection in the BMI > 35 group (p-value 0.01). Intra-operative and post-operative complications occurred in 5 (6.9%) and 11 (15.3%) cases within the BMI ≥ 35 group, respectively, whereas intraoperative and postoperative complications occurred among 9 (9.9%) and 15 (16.5%) cases respectively in patients with a BMI < 35. Conclusion:Despite increased preoperative risks in patients with a BMI ≥ 35, the patients in this study had similar rates of intraoperative and postoperative complications to those with a BMI < 35. Robotic hysterectomy should be considered a safe and effective option for obese women with endometrial cancer.