Yutaka Yoneoka

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.

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.

Tamoxifen, a common adjuvant therapy for hormone receptor-positive breast cancer, is associated with an increased risk of endometrial pathologies, such as hyperplasia, polyps, and carcinoma. This study investigates rapamycin, an mTOR inhibitor, as a potential novel strategy for preventing tamoxifen-induced endometrial proliferation. This in vitro study utilised endometrial stromal cells isolated from infertile women. The cells were treated with tamoxifen alone or in combination with rapamycin, and proliferation was assessed using the CCK-8 assay. The activation of the mTOR pathway, as well as apoptosis and cell cycle markers, was evaluated by Western blotting to elucidate the molecular mechanisms underlying these effects. The study design emphasised simulating clinically relevant exposure levels. Tamoxifen significantly increased endometrial cell proliferation in a dose-dependent manner. Rapamycin effectively inhibited this proliferation, even at concentrations lower than those typically observed in clinical settings. Quantitative analysis by Western blotting showed activation of the mTOR pathway and cell cycle in the tamoxifen group, and inhibition of these pathways in the tamoxifen plus rapamycin combination group, whereas there was no change in apoptosis. In conclusion, rapamycin shows promise as a prophylactic agent against tamoxifen-induced endometrial pathologies, with potential implications for fertility preservation and endometrial protection in breast cancer patients.

Nishimura H, et al. J Gynecol Oncol. 2024 May;36:e2. https://doi.org/10.3802/jgo.2025.36.e2

Objective There is no consensus on whether platinum doublet chemotherapy or lenvatinib and pembrolizumab (LEN/PEM) is superior for advanced or recurrent endometrial cancer. Thus, this study aimed to compare the prognosis and adverse events in patients with advanced or recurrent endometrial cancer treated with platinum doublet chemotherapy or LEN/PEM.Methods We retrospectively reviewed the medical records of patients who received platinum doublet chemotherapy or LEN/PEM at our institution for advanced or recurrent endometrial cancer and had a history of platinum-based chemotherapy between January 2013 and August 2023.Results During the study period, 11 regimens were identified in the platinum doublet chemotherapy group, and 11 regimens were identified in the LEN/PEM group. The objective response rates of the platinum doublet chemotherapy and LEN/ PEM groups were 36.4% and 54.5% (P=0.67), respectively. The 6-month progression-free survival (PFS) rates of the platinum doublet chemotherapy and LEN/PEM groups were 27.3% (95% confidence interval [CI], 13.8%-40.7%) and 70.0% (95% CI, 55.5%-84.5%), respectively. The differences were significant between the two groups. Multivariate analyses of histology, prior lines of chemotherapy, platinum-free intervals, and regimens revealed that the LEN/PEM group had significantly better PFS rates.Conclusion Treatment with LEN/PEM resulted in significantly longer PFS than that of treatment with platinum doublet chemotherapy in patients with advanced and recurrent endometrial cancer. However, further large-scale studies are required to validate these findings.

Introduction: Previously, robotic-assisted laparoscopic total hysterectomy at our institution utilized three arms/four ports (one camera arm, two operating arms, and one assist port). To enhance efficiency, we transitioned to using four arms/five ports (one camera arm, three operating arms, and one assist port) in April 2023. This study aimed to assess the effect of the number of robotic arms on surgical outcomes. Methods: We analyzed cases of robotic-assisted laparoscopic total hysterectomy procedures performed between July 2020 and February 2024, comparing patient data and surgical outcomes between the three-arm and four-arm groups. Results: The study included 110 three-arm and 47 four-arm cases. No significant differences were observed in age, BMI, or uterine weight between the groups. However, the three-arm group exhibited a significantly higher manipulator utilization rate (p < 0.01). Compared to the four-arm group, the three-arm group showed significantly shorter times for console setup, console completion, and total surgery (all p < 0.01). No significant differences were observed in the time from console completion to surgical completion time. Multiple regression analysis indicated that lower BMI and the usage of the three-arm intervention were associated with shorter console setup times, whereas lower uterine weight along with the three-arm intervention, were associated with shorter console and surgical times (all p < 0.01). Discussion: Robotic-assisted laparoscopic total hysterectomy with three arms was found to be as efficient as that with four arms, potentially offering economic benefits through reduced instrument usage.

We report a case of rectovaginal septum carcinosarcoma successfully treated with surgical excision via transanal total mesorectal excision following platinum-based neoadjuvant chemotherapy. A 48-year-old woman presented with a 3-week defecation pain preceding the visit. Pelvic imaging showed an 8-cm sized lesion in the lower rectovaginal septum. Transvaginal biopsy and immunohistochemical analysis were performed. After three courses of carboplatin-paclitaxel-bevacizumab therapy, the mass reduced by half. Subsequently, laparoscopic excision with transanal total mesorectal excision, and radical hysterectomy were performed. The anus was preserved, and dysuria improved within a month. The final histopathological diagnosis was carcinosarcoma of the rectovaginal septum from an uncertain origin, presumably endometriotic or mesonephric. Twelve months following surgery, solitary liver metastasis was confirmed; however, there was no evidence of local recurrence. Total mesorectal excision following platinum-based neoadjuvant chemotherapy may be an ideal treatment for gynecological malignancies in the rectovaginal septum, especially for large tumors localized deep into the pelvis.