Yuji Tanaka

Dissection at the sacral promontory during robot‐assisted sacrocolpopexy (RSC) is technically demanding because of the proximity of major vascular structures and anatomical variability. We report two cases of RSC in which preoperative three‐dimensional (3D) reconstructed imaging and holographic extended reality (XR) visualization were used for surgical planning and intraoperative navigation. In Case 1, 3D reconstructed imaging demonstrated a narrow vascular window anterior to L5, and mesh fixation was performed on the anterior longitudinal ligament over S1 under image‐guided navigation. In Case 2, holographic XR visualization enabled preoperative distance assessment and identification of a vascularly safe region extending approximately 1.7 cm cranial to the sacral promontory, which was subsequently reproduced intraoperatively using the TilePro function on the da Vinci surgeon console. Both procedures were completed without vascular injury. Preoperative 3D reconstruction and holographic XR visualization may facilitate safer sacral promontory dissection during RSC by improving spatial understanding of patient‐specific vascular anatomy and supporting patient‐specific surgical planning and intraoperative navigation.

The pathogenesis and progression of endometriosis may involve a complex combination of multiple factors, including chronic inflammation and oxidative stress. Hormonal therapy, the current standard for pharmacotherapy in endometriosis, causes various issues, such as restricting pregnancy during treatment and a high risk of recurrence after treatment discontinuation. This review investigates the use of lactoferrin (LF), a natural iron-binding glycoprotein, and outlines its mechanism of action, its potential as a non-hormonal therapeutic strategy, prospects for clinical application, and associated therapeutic issues. LF exerts anti-inflammatory, iron-chelating, antioxidant effects, and antiproliferative effects by suppressing signaling pathways and exhibits antifibrotic, antiangiogenic, and antibacterial properties. These are thought to be important physiological factors in endometriosis progression, for which LF exhibits a promising therapeutic candidate that could theoretically replace or complement hormone therapy. Observational studies have reported variations in serum and peritoneal fluid concentrations of LF and anti-LF antibodies in patients with endometriosis depending on the endometriosis stage, depicting LF as a potential therapeutic target. Furthermore, an in vitro study demonstrated that LF selectively induced cell cycle arrest in endometriotic stromal cells without affecting that of eutopic endometrial cells. Compared with other non-hormonal therapies, LF has an extremely lower risk of teratogenicity and fetal toxicity and could improve reproductive outcomes and perinatal prognosis, indicating its potential for continuous administration throughout various life stages. Further studies are needed to determine optimal administration routes and dosages for clinical applications. Graphical Abstract Multiple factors contribute to the pathogenesis and progression of endometriosis, namely, estrogen-responsive growth, inflammation, oxidative stress, signal-dependent cell proliferation, and infection. Lactoferrin targets these pathways through its multifaceted mechanisms of action and offers distinct advantages for patients with endometriosis who wish to preserve their future fertility. Abbreviations: GnRH, gonadotropin-releasing hormone; OC, oral contraceptives

Introduction: Patients with ovarian cancer often present with massive ascites, leading to significant protein loss during surgical procedures. Although cell‐free concentrated ascites reinfusion therapy (CART) is used in palliative settings to mitigate protein loss, its application in intraoperative settings remains unexplored. Methods: We retrospectively evaluated patients who underwent intraoperative CART for ovarian cancer treatment between March 2022 and 2025, compared two ascitic fluid collection methods (syringe and roller pumping), and analyzed operative parameter, fluid collection efficiency, albumin recovery, and adverse event‐related data. Results: Among the 12 patients included in this study, seven (58.3%) underwent CART using the roller pumping method, which significantly reduced the collection time compared with the syringe method (9 vs. 22 min, p < 0.05). The median collection speed was also significantly higher with the roller pumping method (404 vs. 140 mL/min, p < 0.05). Approximately 70% of the albumin in the collected ascitic fluid was successfully reinfused. Adverse events included transient hypotension (16.7%) and hypertension (25.0%), both of which resolved without intervention. Conclusion: Intraoperative CART is a feasible and safe technique for protein loss management in patients undergoing surgery for ovarian cancer. The roller pumping method significantly shortened ascites collection time and reduced surgical burden.

Purpose: To describe age‐specific patterns of gonadotoxic alkylating‐agent exposure and evaluate how the cyclophosphamide equivalent dose (CED) framework captures real‐world exposure relevant to fertility preservation in females aged 0–43 years. Methods: This descriptive study used a Japanese claims database. Patients were classified as pediatric (< 15 years) or reproductive‐age (15–43 years). Twelve alkylating agents were evaluated, and six CED‐calculable agents were converted to CED. Results: Among approximately 3.86 million females, 0.04% of the pediatric cohort and 0.16% of the reproductive‐age cohort were exposed to at least one alkylating agent. Total CED identified at least intermediate‐risk exposure in 33% of exposed pediatric and 14% of exposed reproductive‐age patients. Compared with single‐agent assessment, summed total CED identified additional patients mainly in the pediatric group, corresponding to relative increases of 20.2% and 0.3%, respectively. Agents not included in the current CED formula accounted for 8.7% of all alkylating‐agent prescription records, approximately 90% of which were observed in reproductive‐age patients. Conclusions: CED captured alkylating‐agent exposure differently by age group: summed CED added exposure information mainly in pediatric patients, whereas agents lacking conversion coefficients limited exposure capture in reproductive‐age females. These findings support refinement of CED‐based assessment while emphasizing exposure capture, not outcome prediction.

Objective: Ovarian tissue cryopreservation is an essential fertility preservation technique. Two primary methods are used for ovarian tissue cryopreservation: slow freezing and vitrification. Recently, vitrification has been favored over slow freezing, and a closed system is recommended to prevent cross-contamination in liquid nitrogen. Follicular loss during freezing and thawing remains a major challenge. We investigated whether rapamycin, an inhibitor of the mechanistic target of rapamycin (mTOR) pathway, could mitigate primordial follicle loss during closed-system vitrification and thawing of mouse ovarian tissue. Methods: Mouse ovaries were vitrified and thawed with or without 750 nanomolar rapamycin, then immediately analyzed or cultured for 5 days. Activation of the mTOR pathway was assessed using phosphorylated S6 kinase immunostaining, and follicle survival and development were evaluated by histological analysis. Results: Closed-system vitrification did not induce apoptosis in primordial follicles. The median phosphorylated S6K-positive rate in primordial follicles was 7.1% in fresh controls, 87.9% in the rapamycin-free group, and 19.0% in the rapamycin-treated group (fresh-control vs. rapamycin-free and rapamycin-free vs. rapamycin-treated, both p<0.001). Rapamycin treatment suppressed this activation, resulting in significantly higher primordial follicle counts after culture (605 vs. 289 follicles per ovary, p<0.05) and a lower ratio of primary to primordial follicles, indicating reduced follicle activation. Conclusion: These findings demonstrate that rapamycin preserves the primordial follicle pool by preventing follicle activation during cryopreservation and thawing. Incorporating rapamycin into closed-system vitrification protocols may improve ovarian tissue cryopreservation outcomes and enhance fertility preservation for patients with cancer.

Brain metastases from endometrial carcinoma are extremely rare and associated with poor prognosis. We present a 43‐year‐old woman with mismatch repair deficient endometrial cancer who developed multiple brain metastases refractory to cytotoxic chemotherapy and without extracranial involvement. After stereotactic radiotherapy, combination therapy with lenvatinib and pembrolizumab resulted in sustained partial remission for 16 months, with no evidence of brain hemorrhage. This case demonstrates that lenvatinib plus pembrolizumab may offer an effective and safe therapeutic option for brain metastases from endometrial cancer, even in patients resistant to conventional therapy. Remarkably, this outcome challenges the traditionally poor prognosis of such cases and underscores the potential for novel targeted and immunotherapeutic strategies to redefine the standard of care for this rare and devastating complication.