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Objective: Previous studies have reported an increased risk of vaginal cuff dehiscence following total laparoscopic hysterectomy (TLH) compared with that following total abdominal hysterectomy or vaginal hysterectomy. Although vaginal cuff dehiscence after TLH is rare, it often results in severe complications, and although the cause remains unknown, the use of energy devices in vaginal incision has been implicated. This study investigated whether reducing coagulation hemostasis decreases the risk of vaginal cuff dehiscence. Methods: A total of 863 cases of TLH were analyzed from January 2016 to December 2017 at our hospital. We modified the method of hemostasis of vaginal cuff since January 2017. We followed different methods for hemostasis of the vaginal cuff between January and December 2016 (group A, complete hemostasis) and between January and December 2017 (group B, almost complete hemostasis, except in case of heavy hemorrhage). Group A included 352 cases, and group B included 511 cases. Vaginal dehiscence rates in the two groups were compared using the χ2 test. Results: Vaginal cuff dehiscence was observed in four cases (1.1%) in group A and two cases (0.3%) in group B, which showed drastic reduction. However, no significant difference (p=0.2) was noted. Sexual intercourse was found to be the biggest trigger for the complication (50%). Conclusions: Based on our results, we recommend that decreasing the vaginal cuff coagulation hemostasis can reduce vaginal cuff dehiscence following TLH.

Objective: To clarify the feasibility and safety of laparoscopic surgery for endometrial cancer. Materials and Methods:Ninety-one patients with endometrial cancer who had undergone laparoscopic surgery in our institution between August 2012 and June 2016 were retrospectively studied. Data regarding surgical procedures, blood loss, surgical time, number of harvested lymph nodes, complications, and prognosis of the patients were obtained from medical records and analyzed.Results: All patients had a pathologically confirmed endometrial cancer before the surgery, and their median age was 56 years. Of these, 57 patients underwent total laparoscopic hysterectomy (TLH) and bilateral salpingo-oophorectomy (BSO), and 34 patients underwent lymph node dissection in addition to TLH and BSO. After the surgery, histological examination showed that 78% of cases were high-grade endometrioid adenocarcinoma and 69.2% were the International Federation of Gynecology and Obstetrics (FIGO) stage IA. No case needed conversion to laparotomy or blood transfusion. Based on the Common Terminology Criteria for Adverse Events, complications with grade 3 or more were seen in 6.6% of patients intra-operatively, including venous and nerve injury, and seen in 6.6% of patients postoperatively, including ileus and pelvic abscess. During the follow up period (median of 23 months), 5 patients experienced recurrence, and no patient died of cancer. The rate of complications, number of harvested lymph nodes, and rate of good prognosis of our patients were not lower than that reported by previous studies. Conclusion:The safety of laparoscopic surgery for endometrial cancer performed in our institution was found to similar to that performed in other countries. It should be more widely used worldwide and in Japan for stage IA patients and might be considered for patients with stage IB or higher endometrial cancer.

Background Parasitic myoma is an extrauterine leiomyoma that develops because of feeding of nutrients by vessels from organs other than those of the uterus. Recently, laparoscopic myomectomy has become popular. However, incidences of iatrogenic parasitic myoma have also been reported. In this case, uterine myoma recurred after laparoscopic myomectomy and disseminated lesions were found in the peritoneal cavity with suspected uterine sarcoma.