Duck-Yeong Ro

Single-Port Laparoscopic Myomectomy Using a New Single-Port Transumbilical Morcellation System: Initial Clinical Study

STUDY OBJECTIVE To evaluate the feasibility of single-port laparoscopic myomectomy with transumbilical morcellation and suturing. DESIGN Continuing prospective study (Canadian Task Force classification II-3). SETTING University hospital. PATIENTS Fifteen patients who underwent single-port laparoscopic myomectomy between September 2008 and October 2009 to remove single or multiple uterine myomas, at least 1 in each patient measuring greater than 4 cm in diameter. INTERVENTIONS All single-port laparoscopic myomectomy procedures were performed by a single surgeon (Dr. Y.W. Kim). Myomas were extracted transumbilically by cutting the myomas into smaller pieces with a knife or a conventional electromechanical morcellator. After making a single 1.5- to 2.0-cm umbilical incision, the single-port system, created with a wound retractor and a surgical glove, was inserted. All operations were performed using conventional rigid straight laparoscopic instruments. Laparoscopic suturing was performed in intramural myomas and some subserosal myomas. MEASUREMENTS AND MAIN RESULTS Patient mean (SD; range) age was 38.3 (5.6; 29-49) years. The number of myomas per patient was 1.6 (1.4; 1-6). The diameter of the largest myomas was 6.1 (1.5; 4.2-9.6) cm. In 4 patients, only a knife was required for transumbilical extraction of myomas, and in 11 patients, transumbilical morcellation with an electromechanical morcellator with or without a knife was used. Transumbilical drainage tubes were inserted into the pelvic cavity in 11 of 15 patients. Operative time was 96.7 (33.8; 35-150) minutes. The decrease in postoperative hemoglobin concentration was 1.8 (1.2; 0.4-3.6) g/dL. During the operations, no patients required blood transfusion. No patients developed postoperative fever. Neither bowel injury nor urinary tract injury occurred in any patient. The postoperative hospital stay was 3.1 (0.8; 2-4) days. CONCLUSION Single-port transumbilical morcellation using a conventional electromechanical morcellator with or without a knife is feasible. Single-port laparoscopic myomectomy is an alternative method with cosmetic advantage.

Photodynamic therapy‐generated tumor cell lysates with CpG‐oligodeoxynucleotide enhance immunotherapy efficacy in human papillomavirus 16 (E6/E7) immortalized tumor cells

Immunotherapy with photodynamic therapy (PDT) offers great promise as a new alternative for cancer treatment; however, its use remains experimental. In this study, we examined the immunotherapeutic significance of human papillomavirus (HPV)‐immortalized tumor cell lysates induced by PDT with CpG‐oligodeoxynucleotide (ODN). PDT‐cell lysates were generated by irradiating Radachlorin (5 µg/mL) preloaded TC‐1 cells carrying HPV 16 E7. PDT‐cell lysates plus ODN coinjection for protection against E7‐expressing tumors as well as specific immune responses were evaluated with the following tests: heat shock protein 70 (HSP70) enzyme‐linked immunosorbent assay, in vitro and in vivo tumor growth inhibition, interferon‐γ (IFN‐γ) and tumor necrosis factor‐α (TNF‐α) assay, cytotoxic T‐lymphocyte assay, and fluorescence activated cell sorting (FACS) analysis. PDT‐cell lysates plus ODN coinjection showed a significant suppression of tumor growth at both prophylactic and therapeutic levels, compared to PDT (or F/T)‐cell lysates or ODN alone. In addition, we evaluated the level of the immune response with the coinjection. HSP70, an important regulator of inflammatory and immune response, was observed in abundance in the PDT‐cell lysates. IFN‐γ production and cytotoxic T lymphocytes (CTL) responses were induced by PDT‐cell lysates plus ODN injection. The coinjection resulted in PDT‐cell lysate‐specific antibodies (IgG1, IgG2a, IgG2b, and IgG3) and T‐helper cell responses significantly higher than PDT‐cell lysates alone. Moreover, IFN‐γ production and CTL responses were significantly induced in the PDT‐cell lysate plus ODN immunized groups. These enhanced immune responses appeared to be mediated by CD8+ T cells only. These data suggest that PDT‐cell lysates plus ODN injection may be an effective approach to induce CTL immune responses as a possible immunotherapeutic strategy for cancer therapy. (Cancer Sci 2007; 98: 747–752)

Single-Port Laparoscopic Salpingectomy for Surgical Treatment of Tubal Pregnancy: Comparison with Multi-Port Laparoscopic Salpingectomy

BackgroundThis study investigates the safety and feasibility of transumbilical single-port laparoscopic salpingectomy (SPLS) using conventional laparoscopic instruments compared to conventional multi-port laparoscopic salpingectomy (MPLS) for surgical treatment of tubal pregnancy. Material and methods We conducted a retrospective analysis of 63 patients with tubal pregnancy who underwent SPLS and 71 patients who underwent conventional MPLS between January 2008 and December 2010. All patients in the SPLS group had a drainage tube placed through the umbilicus, and, in the MPLS group, through a 5-mm trocar site in one side of the lower abdomen. Results No significance difference was discovered between the groups with regard to adjusted hemoglobin values (SPLS, 1.9 ± 1.0 g/dL versus MPLS, 1.7 ± 1.0 g/dL, P = 0.335). Additionally, there was also no significant difference in clinical characteristics, intraoperative findings, or operative outcomes. Conclusions Our study demonstrated that transumbilical SPLS using conventional laparoscopic instruments has operative outcomes comparable to MPLS for the surgical treatment of tubal pregnancy. Transumbilical SPLS may therefore be offered as a feasible alternative to MPLS.

Lobular endocervical glandular hyperplasia in a woman with Peutz–Jeghers syndrome: a case report

(Fig. 1F) [1]. The coronal view showed a narrow tubular aspect of the vascular lesion (Fig. 1A) with an intact external part of the uterine wall (thickness of 2.6 mm). A detailed assessment of the vessel flow (Fig. 1B) showed a typical low-resistance pattern in the myometrial venous plexus (Fig. 1D) and strong turbulence where the intramural arterial branches and venous vessels merged (Fig. 1E). The final diagnosis was of intramyometrial arteriovenous shunting secondary to incomplete accidental uterine perforation during a curettage. An office hysteroscopy was carried out showing a fibrotic area on the anterior wall of the uterine cavity that pulsed (Video clip), *Corresponding author at: Department of Obstetrics an Gynecology, Sacro Cuore Don Calabria General Hospita Via Don A. Sempreboni 5, 37024 Negrar, Verona, Italy