The first report of surgery for gynecological diseases using the hinotori™ surgical robot system.

OBJECTIVE: This study aimed to report the first surgery for gynecological diseases using a new robotic platform, the hinotori™, and validate its feasibility in clinical settings. METHODS: The world's first robot-assisted total hysterectomy for a gynecological ailment was carried out at Kagoshima University Hospital in December 2022 utilizing the hinotori™ surgical robot system. Eleven other patients then underwent comparable procedures. The surgical team was certified to execute the procedure and had undergone official hinotori™ training. RESULTS: Preoperative diagnoses indicated five cases of endometrial cancer, four cases of uterine myoma and one case each of atypical endometrial hyperplasia, uterine adenosarcoma and high-grade cervical intraepithelial neoplasia. Median age and body mass index were 51 (range: 38-70) years and 26.9 (range: 17.3-33.3) kg/m2, respectively. Median roll-in, cockpit and operation times were 15 (range: 10-18), 161 (range: 110-225) and 214 (range: 154-287) min, respectively. The median blood loss was 22 (range: 7-83) mL and conversion to laparotomy was not allowed. Only one patient had postoperative pelvic region infection. The median length of hospital stay was 6 (range: 4-10) days. CONCLUSION: Based on our experience with presented 12 cases, robotic surgery with the hinotori™ is a feasible technique of minimally invasive surgery for gynecological diseases.

Laparoscopic Hysterectomy for Uterine Adenomyosis in Patients With a History of Renal Transplant: A Case Report and Review of Literature.

Renal transplantation is a viable treatment option for patients with end-stage kidney disease; however, it requires careful surgical manipulation as the transplanted kidney is placed in the iliac fossa. Herein, we report a case of a 41-year-old female with a history of two renal transplants who presented with hypermenorrhea and dysmenorrhea. Computed tomography revealed transplanted kidneys in the bilateral iliac fossae (right atrophic), and magnetic resonance imaging showed uterine adenomyosis. Three-dimensional computed tomography was performed to determine the relationship between the arteriovenous vessels, iliac vessels, and ureter of the transplanted left kidney. A diamond-shaped trocar was inserted while monitoring the transplanted kidney. Total laparoscopic hysterectomy and bilateral salpingectomy were performed without any perioperative complications. Immunosuppressants were continued postoperatively. Laparoscopic surgery for gynecological diseases can be advantageous and should be considered in patients who underwent renal transplants.

Pattern of a confined chemical garden controlled by injection speed.

Pattern of confined chemical garden was controlled by the speed of injected fluid, and their mechanism is discussed. A confined chemical garden system was constructed where an aqueous solution of cobalt chloride was injected into a cell filled with sodium silicate solution. The reaction of these two solutions resulted in the formation of precipitation. The viscosities of the prepared aqueous solutions were set to be similar in order to rule out the possibility of Saffman-Taylor instability. The injection front showed three distinctive patterns: algaes, shells, and filaments, which were dependent on injection speed. The injection pressure and the spatio-temporal pattern of the injected fluid were measured, and a significant increase in the injection pressure was observed when the filament pattern appeared, which indicated the existence of thin lubrication layer between the precipitation and the substrate. The filament pattern was further analyzed quantitatively, and the number of active filaments was determined to be proportional to the injection speed. A mathematical model was constructed that considered both the viscous effect from the thin lubrication layer and the Laplace pressure. This model successfully reproduced the characteristic filament dynamics.