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Some drugs that regulate estrogen are currently used as therapy for endometriosis. Endometriosis is a disease characterized by the ectopic presence of endometrial tissue. However, these medical treatments have significant side effects and patients who hope to become pregnant cannot overcome infertility. To compare morphological alterations and clinical symptoms, revised American Fertility Society (r-AFS) scores were compared between patients with and without leukotriene receptor antagonist (LTR-A) treatment. LTR-A-treated cases showed significantly de- creased r-AFS score. Furthermore, a significant correlation was seen between r-AFS score and LTR-A treatment period. In treated cases, clinical symptoms decreased and some patients achieved pregnancy. Morphologically, lesions in LTR-A-treated cases showed apoptotic fibroblasts and degeneration of collagen fibers. Our findings revealed that LTR-As had significant therapeutic value for the treatment of human endometriosis. Anti-LT therapy appears efficacious not only in the treatment of clinical symptoms and lesions, but also in improving fertility.

Aim Since 2014, Japan Society of Gynecologic and Obstetric Endoscopy and minimally invasive therapy (JSGOE) conducted a nationwide survey on gynecologic endoscopic surgery. We aimed to evaluate the current status and complications associated with endoscopic surgery by Japan gynecologic and obstetric endoscopy-database registry system (JOE-D). Methods Electrical medical records concerning the endoscopic surgery were generated from the daily use of reporting system. The subjects were all patients who underwent gynecologic endoscopic surgery. In addition to assessment of actual numbers, diagnosis, and operative methods, adverse events were registered. Results Total 203 970 patients performed laparoscopic, hysteroscopic and falloposcopic surgery for 3 years, 2014-2016. The numbers of endoscopic surgeries conducted in 2016 were increased more than 67 000, 13 000 or 450 cases, respectively. Incidence rates of complications involving these three types of surgeries in each year were approximately 3.1%. Incidences of intraoperative complications were relatively high in malignant diseases, laparoscopic-assisted vaginal hysterectomy (LAVH) and myomectomy (LAM). In total laparoscopic hysterectomy/laparoscopic hysterectomy (TLH/LH) performed from 2014 to 2016, ureteral injury as intra and postoperative complication occurred in 0.35%. In the past 3 years, the rates of vascular injury, urinary tract, and bowel injury as intraoperative complications caused by laparoscopic surgery were approximately 0.1%. In the hysteroscopic surgery, the rates of total intra- and postoperative complications were 0.78%. Conclusion We exhibited the current status by the nationwide survey of gynecologic endoscopic surgery all over Japan. Severe intra or postoperative complications were identified over the 3 years at a rate of 0.04%.

Since 2014, Japan Society of Gynecologic and Obstetric Endoscopy and minimally invasive therapy (JSGOE) conducted a nationwide survey on gynecologic endoscopic surgery. We aimed to evaluate the current status and complications associated with endoscopic surgery by Japan gynecologic and obstetric endoscopy-database registry system (JOE-D).Electrical medical records concerning the endoscopic surgery were generated from the daily use of reporting system. The subjects were all patients who underwent gynecologic endoscopic surgery. In addition to assessment of actual numbers, diagnosis, and operative methods, adverse events were registered.Total 203 970 patients performed laparoscopic, hysteroscopic and falloposcopic surgery for 3 years, 2014-2016. The numbers of endoscopic surgeries conducted in 2016 were increased more than 67 000, 13 000 or 450 cases, respectively. Incidence rates of complications involving these three types of surgeries in each year were approximately 3.1%. Incidences of intraoperative complications were relatively high in malignant diseases, laparoscopic-assisted vaginal hysterectomy (LAVH) and myomectomy (LAM). In total laparoscopic hysterectomy/laparoscopic hysterectomy (TLH/LH) performed from 2014 to 2016, ureteral injury as intra and postoperative complication occurred in 0.35%. In the past 3 years, the rates of vascular injury, urinary tract, and bowel injury as intraoperative complications caused by laparoscopic surgery were approximately 0.1%. In the hysteroscopic surgery, the rates of total intra- and postoperative complications were 0.78%.We exhibited the current status by the nationwide survey of gynecologic endoscopic surgery all over Japan. Severe intra or postoperative complications were identified over the 3 years at a rate of 0.04%.

Objective: To study clinical outcomes for different uterine wall incision directions, comparing vertical incision and transverse incision in laparoscopic myomectomy of the intramural myoma.

Some drugs that regulate estrogen are currently used as therapy for endometriosis. However, these medical treatments have significant side effects and patients who hope to become pregnant cannot overcome infertility. To compare morphological alterations and clinical symptoms, revised American Fertility Society (r-AFS) scores were compared between patients with and without leukotriene receptor antagonist (LTR-A) treatment. LTR-A-treated cases showed significantly decreased r-AFS score. Furthermore, a significant correlation was seen between r-AFS score and LTR-A treatment period. In treated cases, clinical symptoms decreased and some patients achieved pregnancy. Morphologically, lesions in LTR-A-treated cases showed apoptotic fibroblasts and degeneration of collagen fibers. Our findings revealed that LTR-As had significant therapeutic value for the treatment of human endometriosis. Anti-LT therapy appears efficacious not only in the treatment of clinical symptoms and lesions, but also in improving fertility.

Recently, surgical treatments for gynecologic benign diseases have become minimally invasive. Thus, in our department, we perform laparoscopic surgery for all cases in which benign tumors are diagnosed, with the exception of cases that are too difficult to treat laparoscopically, such as size or suspected malignancy. We have reported before the efficacy of local infusion of vasopressin for endometrial and dermoid cysts. However, the use of vasopressin for vasocontraction is not indicated and has the possibility for severe complications. Herein we reviewed the cases in which laparoscopic ovarian cystectomies were performed for ovarian dermoid cysts, into non-drug, vasopressin, and epinephrine groups, and examined retrospectively about the age, diameter of tumors, haemorrhage, and operative time. We examined the cases in which laparoscopic ovarian cystectomies were performed for ovarian dermoid cysts in our hospital between January 2005 and March 2009. We performed ovarian cystectomies by using 100X diluted vasopressin or 1,000,000X diluted epinephrine, locally infused into a crevice of walls of ovarian cysts and normal ovarian tissues. There were no significant differences between the three groups in age, diameter of tumors, and operative times. Significant differences were shown with respect to haemorrhage (36.2 ±38.4 ml for the non-drug group, 3.4±6.3 ml for the vasopressin group, and 12.5±23.1 ml for the epinephrine group). More research will be necessary to reduce the haemorrhage equivalent to the use of vasopressin, by modifying the concentration of epinephrine. In the future, we will change the level of epinephrine administration, and it is thought that it is necessary to review whether or not there is an equal reduction in the hemorrhage effect with vasopressin.

Problem: The proliferation of stromal cells in endometriosis promotes extensive adhesion; therefore, the morphological analysis of stromal lesions is important in the investigation of the pathogenesis of endometriosis. Method of Study: In this study, the morphological and numeric comparisons of degranulated mast cells were performed between endometriotic lesions and comparative regions (eutopic endometrium and normal uterine serosa) of patients with and without endometriosis. Results: In cases of endometriosis, diffuse infiltration of numerous mast cells was observed throughout the stromal lesions. These mast cells exhibited degranulation, and scattered granules were also observed. In the eutopic endometrium and normal uterine serosa of both the endometriosis patients and the controls, mast cells were rarely detected. Conclusions: These results suggest that an abnormal immune response, specifically a hypersensitivity reaction, is strongly related to endometriosis; our findings will be helpful in the development of methods for the treatment of endometriosis.

To evaluate the effect of leukotriene receptor antagonist (LTR-A) on human endometriosis, we examined morphological alterations under light and electron microscope, clinical symptoms, and formation of fibrous adhesion using the revised American Fertility Society classification (r-AFS score) in endometriosis cases with and without LTR-A treatment. Morphologically, the lesions of LTR-A-treated cases showed not only decrease of activated mast cells but also numerous apoptotic fibroblasts. Collagen fibers around these apoptotic fibroblasts were filamentous and thin compared with those of nontreated cases, partially condensed or disappeared completely. In LTR-A-treated cases, a significant decrease of r-AFS score was observed (p

The proliferation of stromal cells in endometriosis promotes extensive adhesion; therefore, the morphological analysis of stromal lesions is important in the investigation of the pathogenesis of endometriosis.In this study, the morphological and numeric comparisons of degranulated mast cells were performed between endometriotic lesions and comparative regions (eutopic endometrium and normal uterine serosa) of patients with and without endometriosis.In cases of endometriosis, diffuse infiltration of numerous mast cells was observed throughout the stromal lesions. These mast cells exhibited degranulation, and scattered granules were also observed. In the eutopic endometrium and normal uterine serosa of both the endometriosis patients and the controls, mast cells were rarely detected.These results suggest that an abnormal immune response, specifically a hypersensitivity reaction, is strongly related to endometriosis; our findings will be helpful in the development of methods for the treatment of endometriosis.

To investigate the pathophysiology of human endometriosis, we examined by morphological and molecular biological methods. Samples of ovarian endometriosis and normal ovarian tissues were obtained laparoscopically after informed consent. A morphological study by toluidine blue staining, immunohistochemistry of c-kit and electron microscopy demonstrated the localization of mast cells in the stromal lesions of endometriosis. Oligonucleotide microarrays were used for gene expression analysis. Infiltration of numerous mast cells and development of fibrosis was observed throughout the stromal lesions. Gene expression analysis by oligonucleotide microarrays indicated inflammatory immunoreactions in the lesions. Expressions of the FCERlG and PGDS, which are considered to be mast cell-specific genes, were upregulated in the ovarian endometriotic lesions as compared to the normal ovarian tissues. Furthermore, expressions of genes associated with immunological inflammation, such as IL-8, GRO1, GRO2, CXCR4, MCP1, and those related to tissue remodeling (MMP, COLAA2, and COL5A2) were also higher in endometriotic lesions than in the normal ovarian tissue. Thus it is likely that mast cells and their related inflammatory immunoreactions via chemokines play important roles in producing fibrosis and adhesions in endometriotic lesions.

Objective To evaluate the effect of antileukotriene therapy, we examined the morphologic alteration in experimental rat endometriosis both with and without leukotriene receptor antagonist treatment. Design Light and electron microscopic analysis. Setting Tochigi Institute of Clinical Pathology, Japan. Animal(s) Female Sprague-Dawley rats maintained on a schedule of 12 hours of light and 12 hours of dark for 2 weeks. Intervention(s) Uterine transplants were attached to rat peritoneum via the surgical autotransplantation technique. After autotransplantation, the rats were given daily administration of leukotriene receptor antagonist, and the lesions were examined at 4 and 7 days after autotransplantation. Main outcome measure(s) The morphologic comparison of rat endometriosis with and without antileukotriene therapy. Result(s) In the rats treated with leukotriene receptor antagonist, a significant decrease in stromal proliferation was observed when compared with nontreated rats. The treated rats showed not only the suppression of infiltration and activation of mast cells but also widespread apoptosis of proliferative fibroblasts in the lesions. Conclusion(s) Our results reveal that a leukotriene receptor antagonist has significant therapeutic value for the treatment of rat endometriosis. It is likely that antileukotriene therapy would be efficacious in the treatment and prevention of human endometriosis.

Objective: To observe in detail the morphology of experimental rat endometriosis, specifically in peritoneum adjacent to uterine transplants attached via autotransplantation. Design: Light and electron microscopic study. Setting: Tochigi Institute of Clinical Pathology, Japan. Animal(s): Female-SD rats maintained on a schedule of 12 hours of light and 12 hours of dark for 2 weeks. Intervention(s): Uterine transplants were attached to rat peritoneum via the surgical autotransplantation technique. The implanted area of peritoneum, including abdominal muscle, were excised from anesthetized rats at four (n = 10), seven (n = 10), and 14 (n = 10) days after uterine autotransplantation. The mesenteries were autotransplanted as a comparative control. Main Outcome Measure(s): We examined the morphologic alterations of uterus-attached peritoneum following the time interval after the implantation. Result(s): In rat endometriosis models, the stromal tissue of uterus-attached peritoneum showed proliferation and infiltration of mast cells, eosinophils, plasma cells, lymphocytes, and macrophages. These lesions increased with time after implantation; however, ultimately these infiltrating cells disappeared and proliferation declined. Conclusion(s): Our findings suggest that uterine autotransplantation induces the infiltration of allergic inflammatory-related cells and proliferative lesions in peritoneal stroma attached endometrium. These data should prove useful for investigations of human endometriosis.