[A Case of Two-Stage Radical Resection with Neoadjuvant Chemotherapy for Cecal Cancer with Synchronous Peritoneal Metastasis(P3)].

A 63-year-old female patient was diagnosed with cecal cancer(cT3, N2a, M0)and underwent surgery for the first time. Only laparoscopic ileocecal resection(D3 dissection)was performed because intraperitoneal observation revealed peritoneal metastasis around the tumor and uterus. We decided to perform a radical resection because the peritoneal metastasis was localized by FDG-PET/CT. Five courses of neoadjuvant chemotherapy(mFOLFOX6)were performed to shrink the tumor. Unrecognized peritoneal metastases were found in other areas during the second surgery. Although the extent of the peritoneal metastasis was P3, all lesions had been resected. No perioperative complications occurred, and adjuvant chemotherapy was administered to the patient. Recurrence was not observed until 6 months postoperatively.

Conservative medical management combined with follow-up multidetector computed tomography of tracheobronchial injury caused by penetrating injuries: A case report.

Tracheobronchial injury (TBI) associated with penetrating injuries has various clinical symptoms and often requires urgent surgical repair. A tracheal tube and/or placement of a drainage tube combined with multidetector computed tomography (CT) could be used to manage TBI without surgical repair in eligible patients. In this case report, we describe an 86-year-old woman with subcutaneous emphysema and suspected TBI caused by three knife wounds in her neck. After tracheal intubation at a local hospital, she was transferred to our hospital. On admission, she was diagnosed with subcutaneous and mediastinal emphysema due to TBI, as well as bilateral pneumothorax. We adjusted the position of the tracheal tube to a distal location from the TBI, and placed bilateral thoracic drainage tubes by referring to the CT images taken on admission and during the follow-up. The follow-up CT images revealed healing of the TBI. She did not show any worsening of her symptoms and she was successfully extubated on day 10 of her hospital stay. On day 18, she was considered self-reliant and was transferred to her previous hospital. Based on our experience in this case, we believe that ventilation with appropriate sedation, placement of a tracheal tube, and drainage are important conservative therapies for TBI caused by penetrating injuries. CT is also useful for evaluating the status of TBI.

Retrospective Study of Collection Methods in Laparoscopic Myomectomy.

INTRODUCTION: After a FDA recommendation in April 2014, power morcellation (PM) in laparoscopic myomectomy (LM) has become less common. We now collect a myoma using manual morcellation (MM) from a wound in the umbilical region. In this study, we compared the PM and MM methods. METHODS: The subjects were 69 patients who underwent LM from April 2013 to March 2016 using PM (n = 37) or MM (n = 32). With PM, the myoma was collected using a 4-hole 12-mm parallel trocar in the left lower abdomen. Using MM, an EZ ACCESSTM (2-cm skin incision) was placed on the umbilical region, and the myoma was put in a collection purse and guided into the access hole for MM using scissors under direct vision. RESULTS: None required allogeneic transfusion or a transition to open surgery, and had surgical or post surgical complications. At multiple linear regression analysis, which was adjusted by age, body mass index, and intraoperative blood loss, significant difference was not observed in operation time between the PM and MM groups. CONCLUSION: Manual morcellation was found to be a safe method for collection of myoma that prevents scattering of tissues and does not prolong the operation time.

Exome and copy number variation analyses of Mayer-Rokitansky-Küster- Hauser syndrome.

Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is characterized by congenital absence of the vagina and uterus. We conducted genome-wide SNP analyses and exome sequencing to detect the causes of MRKH syndrome. We identified de novo variants of MYCBP2, NAV3, and PTPN3 in three families and a variant of MYCBP2 in a sporadic case. Here, we demonstrated the partial genetic makeup of Japanese MRKH syndrome.

Laparoscopic Davydov Procedure for the Creation of a Neovagina in Patients with Mayer-Rokitansky-Kuster-Hauser Syndrome: Analysis of 7 Cases.

OBJECTIVE: Several surgical techniques have been described for creating a neovagina in patients with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome, however as yet there is no standardized treatment. The aim of this report is to assess anatomic and functional outcomes after the laparoscopic Davydov procedure for the creation of a neovagina in patients with MRKH syndrome. METHODS: Seven patients with MRKH syndrome underwent the laparoscopic Davydov technique from January 2005 to August 2010. The anatomic and functional results were evaluated after 3, 6, 12, 24, 36, 48, and 60 months. RESULTS: The surgical procedure was performed with no major complications except in one case in which an intraoperative bladder injury occurred and was successfully corrected. The mean duration of surgery was 162.9 minutes (range, 120-230 min). Mean lengths/widths (cm) of the neovagina were 6.4/2.6, 6.5/2.5, 6.5/2.8, 6.4/2.8, 7.1/2.8, and 7.2/2.8 at 3, 6,12, 24, 36, 48, and 60 postoperative months, respectively. CONCLUSION: The laparoscopic Davydov procedure seems to be a safe and effective surgical treatment for patients with MRKH syndrome if postoperative intermittent self dilation was done.

Uterine rupture at 26 weeks of pregnancy following laparoscopic salpingectomy with resection of the interstitial portion: a case report.

Uterine rupture in pregnancy can occur in patients with a history of uterine surgery such as myomectomy and Cesarean section. Here, we report a case of spontaneous uterine rupture that occurred in the early third trimester in a pregnant woman who had previously undergone laparoscopic removal of the right fallopian tube and interstitial portion for treatment of interstitial pregnancy. The patient presented with sudden onset of abdominal pain at 26 weeks of gestation. Detailed ultrasonography and magnetic resonance imaging led to diagnosis of uterine rupture. In emergency laparotomy, the fetus was delivered by Cesarean section, the placenta and membranes were removed, and the uterus was preserved with closure of the rupture and wound. This case highlights the importance of close follow-up of a pregnant patient who has previously had a uterine incision. The case also raises the question of whether the prevalence of uterine rupture may increase as more patients are treated with laparoscopic surgery of the uterus.

Successful term delivery after laparoscopic resection of a non-communicating rudimentary horn in a patient with a unicornuate uterus: a case report.

Unicornuate uterus accompanied by a non-communicating rudimentary horn is a rare uterine malformation. If a embryo is implanted into the rudimentary horn, continuation of pregnancy is difficult due to the risk of uterine rupture. We recently performed laparoscopic resection of the right rudimentary horn after two right rudimentary horn pregnancies in a woman, in whom a normal pregnancy occurred in the left unicornuate uterus, leading to successful delivery of a baby. This case is presented herein. The diagnostic procedures leading to identification of this rare malformation were prompted by inability to remove uterine contents during surgery performed after a diagnosis of missed abortion. A right rudimentary horn pregnancy, which had occurred twice, was treated with methotrexate. To prevent further pregnancy in the right rudimentary horn, resection of this rudimentary horn was planned and successfully implemented under laparoscopic guidance. This surgical procedure is usually difficult, but fertility could be preserved by employing minimally invasive surgery, involving the use of a LigaSureTM Vessel Sealing System to avoid ligation and assure virtually no bleeding. Soon after surgery, a natural pregnancy in the left unicornuate uterus was confirmed. Intrauterine fetal growth was normal, and transvaginal delivery at term was possible.