No abstract

Postoperative adhesions can cause complications such as chronic pelvic pain, ileus, and infertility. However, the frequency of these adhesions has been found to decrease with the use of anti-adhesion materials, such as adhesion barriers. An adhesion barrier (Seprafilm ® , Kaken Pharmaceutical, Tokyo) is a fragile film that is susceptible to damage by external forces. Thus, for laparoscopic surgery, it is necessary to devise a technique for careful insertion and adherence in the abdominal cavity.There are many reported techniques for the use of this film in laparoscopic surgery. For example, the Cylinder-Roll technique, which involves loading a film into a cartridge of a Sterilized Lap Sponge (TroX ® II-D type, Osaki Medical, Aichi) and inserting it into the abdominal cavity using a 5-mm-diameter trocar. However, the Cylinder-Roll technique has

Following gynecologic surgery, postoperative adhesions commonly cause intestinal obstruction; therefore, the anti-adhesion materials used are of great importance. Currently, various anti-adhesion materials are used, including regenerated cellulose (Interceed, Johnson and Johnson, Ltd) and carboxymethylcellulose hyaluronate (Seprafilm, Kaken Pharmaceutical, Ltd).At our hospital, total laparoscopic hysterectomy (TLH) is performed using only 5 mm ports in four places (diamond placement) to reduce the wound pain and need for plastic surgery. The adhesion preventive material is placed intraperitoneally, which is sometimes difficult.Here, we demonstrate a new method for placing large-sized Interceed in the abdominal cavity, which we call the "Hakama" method. The purpose of this method is to reduce the placement and application time compared to the conventional method.Methods: Twenty patients (10 treated with the Hakama method and 10 with the conventional method) who underwent TLH at our hospital between April 2018 and April 2019, were included in this study. To evaluate and compare both methods, the time to place the Interceed in the abdominal cavity and the time taken for it to adhere (time from placement to adhesion) were noted. Results:The median (range) placement times were 16.5 s (12-35 s) and 24.5 s (13-34 s) and the application times (range) were 106.5 s (64-156 s) and 140.5 s (89-200 s) for the Hakama and conventional methods, respectively (p = 0.15 and 0.02; Fig. 2a and 2b, respectively,). Neither method resulted in damage to the large-sized Interceed. Conclusion:We devised a new method for the intraperitoneal delivery of a large-sized Interceed in TLH using only 5 mm ports. The Hakama method requires only a simple incision and no other special materials or procedures. In addition, the procedure is relatively easy, and it is possible to quickly place the Interceed in the abdominal cavity with a single motion. Moreover, since the shape of the Interceed matches the open part of the retroperitoneum, the relative ease and convenience of attachment is enhanced. With this method, it is possible to use the anti-adhesion agent safely and quickly, while contributing to a shortened TLH operation time using only 5 mm ports.

Background For women diagnosed with hereditary breast and ovarian cancer, the clinical guidelines recommend risk-reducing salpingo-oophorectomy at age 35–40 years or after completion of childbearing. However, there is limited information regarding the current status of risk-reducing salpingo-oophorectomy in Japan. Methods To clarify factors influencing decision-making for risk-reducing salpingo-oophorectomy among Japanese women diagnosed with hereditary breast and ovarian cancer and their clinical outcomes, we analyzed the medical records of 157 Japanese women with germline BRCA pathogenic variants (BRCA1 n = 85, BRCA2 n = 71 and both n = 1) at our institution during 2011–21. Specimens obtained from risk-reducing salpingo-oophorectomy were histologically examined according to the sectioning and extensively examining the fimbriated end protocol. Results The risk-reducing salpingo-oophorectomy uptake rate was 42.7% (67/157). The median age at risk-reducing salpingo-oophorectomy was 47 years. Older age, married state and parity were significantly associated with risk-reducing salpingo-oophorectomy (P < 0.001, P = 0.002 and P = 0.04, respectively). History of breast cancer or family history of ovarian cancer did not reach statistical significance (P = 0.18 and P = 0.14, respectively). Multivariate analyses revealed that older age (≥45 years) and married state may be independent factors associated with risk-reducing salpingo-oophorectomy. Interestingly, the annual number of risk-reducing salpingo-oophorectomy peaked in 2016–17 and has increased again since 2020. The rate of occult cancers at risk-reducing salpingo-oophorectomy was 4.5% (3/67): ovarian cancer (n = 2) and serous tubal intraepithelial carcinoma (n = 1). Conclusion Age and marital status significantly affected decision-making for risk-reducing salpingo-oophorectomy. This is the first study to suggest possible effects of Angelina Jolie’s risk-reducing salpingo-oophorectomy in 2015 and the National Health Insurance introduced for risk-reducing salpingo-oophorectomy in 2020. The presence of occult cancers at risk-reducing salpingo-oophorectomy supports clinical guidelines recommending risk-reducing salpingo-oophorectomy at younger ages.

No abstract