Ovarian tumor cases that were preoperatively diagnosed as benign but postoperatively confirmed as borderline or malignant after laparoscopic surgery

AbstractObjectiveLaparoscopic surgery is the gold standard for benign ovarian tumors because of its overall improved quality of life (QOL). However, some tumors diagnosed preoperatively as benign may be proven to be malignant by postoperative studies. The standard approach for the removal of a malignant ovarian tumor in our hospital is via laparotomy; however, there is no referential prognostic data on malignancies that are excised laparoscopically. To evaluate clinical and histological factors and prognosis, this study retrospectively reviewed patients who underwent surgery in our hospital, based on a preoperative diagnosis of benignancy, but later postoperative testing proved their tumors to be borderline or malignant.Participants and methodsThe study group comprised 1322 women who underwent a laparoscopic procedure in our hospital on the basis of a preoperative diagnosis of a benign ovarian tumor. The procedures were performed between 1995 and 2011. The rate of borderline and malignant cases, histology, and postoperative treatment were investigated.ResultsOf the 1322 patients, 15 (1.1%) patients were postoperatively diagnosed as having a borderline malignancy with various histological types and all of these patients had a good prognosis; four (0.3%) patients were postoperatively diagnosed as having a malignant tumor with various histological types; of these patients, two patients required emergency surgery. All four patients underwent additional surgery and chemotherapy with no recurrence to date.ConclusionSome tumors diagnosed preoperatively as benign proved postoperatively to be malignant. Appropriate postoperative treatment effectively improved the prognosis. Particular attention should be paid to a possible occult malignancy that may manifest postoperatively, especially in patients who underwent emergency surgery. We recommend preoperative magnetic resonance imaging, even for emergency cases, to improve preoperative diagnosis

Indication for Laparoscopically Assisted Vaginal Hysterectomy

When uterine weight is greater than 800 grams, total abdominal hysterectomy is more appropriate than laparoscopic-assisted vaginal hysterectomy

腹腔鏡検査にて確定診断に至った結核性腹膜炎の一例

　症例は63歳女性．元医療従事者であった．１ヵ月続く腹痛と38度の発熱で近医を受診し，腹水貯留を認め，腹水検査でヒアルロン酸とCA125が高値であったことから癌性腹膜炎を疑われ当院内科に紹介された．画像検査より癌性腹膜炎を疑われたが，原発は同定できなかった．細胞診はclassII であったが，卵巣癌，腹膜癌，悪性中脾腫を疑われたことから，腹腔鏡検査目的に当科紹介となった．腹腔鏡検査で黄白色粒状の病変を認め，病理組織検査にて類上皮細胞性肉芽腫を認め，結核等の感染症が疑われた．病歴聴取にて３年前の職務中に結核排菌患者に濃厚接触歴あり，腹腔鏡再検査にて，塗抹，培養，PCR 陰性であったが，腹水中ADA 高値より結核と診断し結核専門病院に転院した．抗結核薬開始され速やかに症状は軽快した．結核性腹膜炎は非常に稀な疾患であるが，腹腔鏡検査で診断に至った症例を経験した．原因不明腹水を認めた場合，癌性腹膜炎のみならず感染性腹膜炎の可能性も念頭に置き早期から同時に精査する必要がある．　A 63-year-old woman, who was a former healthcare professional, visited a nearby clinic for headache and a fever of 38℃ that had lasted for a month. Ascites was observed, and ascitic fluid examination showed high hyaluronan and CA125 levels, suggesting cancerous peritonitis. She was referred to the internal medicine department at our institution. Although the primary site was not identified, imaging findings suggested cancerous peritonitis. Cytology showed class II features, with the possibility of ovarian cancer, peritoneal cancer, or malignant mesothelioma. She was referred to our department for laparoscopic examination, which showed epithelioid cell granulomas, suggesting an infectious disease, which could include tuberculosis. History taking revealed close contact with a tuberculosis-shedding patient at work 3 year ago. Although the smear, culture, and polymerase chain reaction tests were negative, on laparoscopic reexamination, tuberculosis was diagnosed because of elevated adenosine deaminase in the ascitic fluid. She was transferred to a tuberculosis specialty hospital;antituberculosis therapy was started, and the symptoms quickly resolved. We experienced a very rare case of tuberculous peritonitis, diagnosed laparoscopically. Ascites from an unknown cause requires close examination for not only cancerous peritonitis but also infectious peritonitis

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

〈Cases Reports〉 Postoperative urinary stress incontinence after Le Fort colpocleisis

[Abstract] A 72-year-old woman, gravida 4 and para 2, came to our hospital with symptoms of pelvic prolapse. Pelvic examination was performed bya gynecologist and she was diagnosed with prolapse of the uterus. A pessary was inserted into the vagina for conservative treatment. As a result, the symptoms of uterine prolapse improved, but urinary urgency and stress incontinence appeared. The patient requested radical surgery, so we performed Le Fort colpocleisis. The surgery was completed successfully and she was discharged with well-healed wounds ten days later. Two weeks later urinary urgency and stress incontinence were developed. A second surgery, using TOT (transobturator tape) were performed by urologists. As a result, thesymptoms of urinary incontinence disappeared. We therefore report that combined treatment with colpocleisis and TOT is possible

WITHDRAWN: Ovarian tumor cases preoperatively diagnosed as benign but postoperatively confirmed as borderline or malignant after laparoscopic surgery

The Publisher regrets that this article is an accidental duplication of an article that has already been published http://dx.doi.org/10.1016/j.gmit.2013.07.002. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy