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Objective: The laparoscopic approach to cervical cancer (LACC) trial highlighted the necessity of an open approach for radical hysterectomy due to its negative impact on oncological outcomes. While minimally invasive surgery is an option for other organ cancers, its application in cervical cancer remains a challenge for surgeons. In this study, we aimed to assess the oncological outcomes of patients with early-stage cervical cancer who underwent minimally invasive radical hysterectomy performed by experienced oncologic endoscopists in gynecology at a single institution. Materials and methods: This study was a retrospective chart review conducted at Chang Gung Memorial Hospital, Linkou, between 2014 and 2023. We retrospectively analyzed clinical data from patients diagnosed with the International Federation of Gynecology and Obstetrics (FIGO) 2018 stage IA1 to IB1 cervical cancer. Patients underwent laparoscopic radical hysterectomy performed by experienced oncologic endoscopists in gynecology. Results: Our analysis included 22 patients, with 5 at FIGO stage IA1, 3 at IA2, and 14 at IB1. The median operation time was 274 min (range: 173–410 min), with an estimated blood loss of 125 mL (range: 50–300 mL). While no major intraoperative complications were observed, one patient reported a poor sensation of urination postoperatively. No recurrences or mortality occurred during the follow-up period. Conclusion: Our findings suggest that minimally invasive radical hysterectomy performed by experienced oncologic endoscopists in gynecology is a viable treatment option for early-stage cervical cancers with a diameter of ≤2 cm.

Abstract Cervical cancer is a significant public health concern, particularly in low‐ and middle‐income countries where resources for prevention and treatment are limited. Routine screening, such as the Papanicolaou test (Pap smears) and human papillomavirus (HPV) testing, plays a crucial role in the early detection and prevention of cervical cancer. However, the participation rate in cervical cancer screening programs remains below optimal levels due to various factors. This study aimed to evaluate the reliability and acceptability of the HygeiaTouch Self Sampling Kit for Women in collecting vaginal samples for HPV typing, comparing the results with samples collected by physicians. The study included 1210 women aged 21–65 from three medical centers in Taiwan. The findings indicated that the self‐sampling kit was as effective as physician‐collected specimens in terms of obtaining valid samples and identifying HPV. The agreement between the two methods was 88%, with a κ value of 0.75. Furthermore, the study assessed the mechanical characteristics of the self‐sampling applicator through tensile, bending, and torque tests, and determined that it was safe for intravaginal use. Additionally, the study evaluated the safety and satisfaction of self‐sampling and found a low rate of adverse events (0.7%) and high levels of satisfaction (over 90%) among participants. Overall, we demonstrated that the HygeiaTouch Self Sampling Kit for Women is a reliable and acceptable device for HPV testing and cervical screening, providing a convenient, safe, and effective alternative for women.

A case of a 32-year-old patient who presented with vaginal bleeding 2 years after undergoing laparoscopic radical trachelectomy and vaginal cerclage was noted to have Mersilene tape erosion. Subsequent management includes the removal of displaced Mersilene tape and a repeat cerclage through a new technique of laparoscopic abdominal cerclage to avoid repeat tape erosion. The novel technique of laparoscopic abdominal cerclage to lower the incidence of preterm delivery among pregnant patients who underwent laparoscopic radical trachelectomy for early-stage cervical cancer is described.

Objective: Laparoscopic box simulation training is widely recognized as an assessment tool to facilitate psychomotor skills especially for novice surgeons. However, current commercialized training modules including pegs, gauze, clips, pins etc. are generally costly and relatively inaccessible. We introduce a simple and pioneer surgical training drill, the Origami Box Folding Exercise (OBFE), based on the validated evaluating system of objective structured assessment of technical skills (OSATS) constructed with the scoring system of procedure-specific checklist (PSC) and global rating scale (GRS). Materials and methods: Face and content validation of the OBFE and OSATS are evaluated by five endoscopic experts from two medical centers in Taiwan. This is a prospective observational study analyzing the pre-test/post-test result of OBFE from 37 participants in two individual workshops as training and evaluating method for laparoscopic psychomotor skills. Both the pre and post tests are video recorded with a time limit of 5 min graded by two independent evaluators based on the OSATS scoring system. Results: The reliability of PSC, GRS, and intergroup value between PSC and GRS were 0.923, 0.926 and 0.933, respectively. Inter-rater reliability of PSC, GRS, and both were 0.985, 0.932 and 0.977, respectively. Construct validity of PSC and GRS were statistically significant, with p-value 0.006 and 0.001, respectively. Conclusion: OBFE enhances laparoscopic psychomotor skills with requirement of a single piece of paper. The associated OSATS tool for a 5-min OBFE test was validated. OBFE training is an efficient training and assessment system to promote psychomotor skills in laparoscopic box simulation drill which requires simple and economical preparation.

Background: We investigated whether mutations in plasma circulating tumor DNA (ctDNA) can provide prognostic insight in patients with different histological types of ovarian carcinoma. We also examined the concordance of mutations detected in ctDNA samples with those identified in the corresponding formalin-fixed paraffin-embedded (FFPE) tumor specimens. Methods: Between July 2016 and December 2017, 29 patients with ovarian carcinoma were prospectively enrolled. FFPE tumor specimens were obtained from all participants. A total of 187 blood samples for ctDNA analysis were collected before surgery (C0), immediate after surgery before adjuvant chemotherapy (C1), and at six-month intervals. Progression-free survival (PFS) and overall survival (OS) served as the main outcome measures. Results: The study cohort consisted of 13 (44.8%) patients with high-grade serous carcinomas (HGSC), 9 (31.0%) with clear cell carcinoma, 2 (6.9%) with mucinous carcinomas, 4 (13.8%) with low-grade serous carcinomas, and 1 (3.4%) with endometrioid carcinoma. Twenty-four (82.8%) patients had at least one detectable ctDNA variant. The concordance rate between mutations identified in pretreatment ctDNA and corresponding FFPE tumor specimens was 92.3% for patients with HGSC and 58.6% for the entire cohort. The median follow-up time was 33.15 months (range: 0.79–46.13 months). Patients with an advanced stage disease more likely had detectable ctDNA mutations before surgery (C0) and after surgery at C1, while those with HGSC more likely had ctDNA mutations detected before surgery. The presence of ctDNA mutations at C1 was an independent predictor of worse OS with a hazard ratio of 6.56 (95% confidence interval, (1.07–40.17) for detectable versus undetectable C1 ctDNA variants, p = 0.042). Conclusions: ctDNA mutations are common in patients with ovarian carcinoma. The presence of ctDNA mutations after surgery was an independent predictor of less favorable PFS and OS.

Background: To investigate outcomes and morbidity of patients undergoing secondary cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in recurrent ovarian cancer. Materials and methods: Between April 2014 and January 2019, a total of 51 recurrent ovarian cancer patients receiving secondary CRS and HIPEC were retrospectively reviewed. Results: Among the 51 patients, median peritoneal cancer index score was 13 (range 3–34), and completeness of cytoreduction (CC) score of 0/1 was achieved in 41 patients (78.8%). Regimen of HIPEC included cisplatin and paclitaxel in 39 (75%) cases. The median follow-up duration of survivors was 20.2 months. Sixteen (30.8%) patients remained free of recurrence after HIPEC. The median progression-free survival (PFS) and overall survival (OS) were 11.8 months and 34.5 months respectively. Multivariate analysis showed previous chemotherapy

Objective: This study compared the outcomes of laparotomic radical hysterectomy (LRH) and minimally invasive radical hysterectomy (MISRH) in patients with early-stage cervical cancer. Methods: The clinical data of patients with early-stage cervical cancer who underwent LRH or MISRH (laparoscopic/robotic) at Chang Gung Memorial Hospital, Linkou Branch, from 2002 to 2017 were retrospectively reviewed. The surgical safety (operation time, blood loss, blood transfusion rate, length of postoperative stay, and perioperative complications), overall survival (OS), disease-free survival (DFS), and recurrence pattern were analyzed. Propensity score matching (PSM) at a 3:1 ratio was performed to balance prognostic variables. Results: Of the 760 patients (entire cohort), 614 underwent LRH and 146 underwent MISRH. After PSM, 394 and 140 patients were included in the LRH and MISRH groups, respectively. The 5-year OS rate was significantly lower in the MISRH group than in the LRH group (85.6% vs. 93.2%, p=0.043), and the 5-year DFS rate (p=0.21) did not differ significantly. After PSM, the 5-year OS rates did not differ significantly between the MISRH and LRH groups (87.1% vs. 92.1%, p=0.393). The MISRH group had a significantly shorter operation time (p<0.001), lower intraoperative blood loss (p<0.001), lower blood transfusion rate (p<0.001), and shorter postoperative stay (p<0.001) but a significantly higher rate of intraoperative bladder injury (p<0.001) than the LRH group. Conclusion: After PSM, MISRH is associated with nonsignificantly lower OS but a significantly higher risk of intraoperative urological complications than LRH. [ABSTRACT FROM AUTHOR]

Objective: Minimally invasive radical hysterectomy has been shown to be associated with poorer outcome in an influential prospective, randomized trial. However, many centers worldwide performing minimally invasive radical hysterectomy have data and experience that prove otherwise. We aim to review surgical and oncologic outcomes of patients operated by Laparoscopic Radical Hysterectomy in a tertiary hospital, by experienced surgeons and standardization in radicality, for cervical carcinoma Stage 1A1-1B1 from January 2009 to May 2014. Materials & methods: Standardised surgical technique with Parametrium & Paracolpium resection approach was adopted by qualified and experienced Gynecologic/Gyne-Oncologic Endoscopic & Minimally Invasive Surgeons in performing Laparoscopic Radical Hysterectomy for Cervical Cancer stage 1A1-1B1 from January 2009–May 2014, involving 53 patients. Electronic Medical Record system (EMR) Of Chang Gung Memorial Hospital(Tertiary Referral Centre), Department of Obstetrics & Gynecology was accessed for surgical and oncologic outcomes. Results: Fifty-Three patients operated from January 2009 to May 2014 were followed up for an average of 96.7 months with longest follow-up at 127 months. There were no cases of recurrence or death reported. 5 Year – Survival Rate and 5 Year Disease-Free Survival Rate were 100%. Two patients received post-operative pelvic radiation concurrent with chemotherapy using Cisplatin due to greater than 1/3 cervical stromal invasion. Conclusion: It is vital to standardize minimally invasive surgical techniques for early stage cervical cancer, with focus on adequate radicality and resection which may contribute to excellent survival outcomes. Further international multi-center randomized trial (Minimally Invasive Therapy Versus Open Radical Hysterectomy In Cervical Cancer) will provide justification for continued practice of MIS in early stage cervical cancer.

A 38-year-old para-2 female underwent laparoscopic myomectomy with uncontained morcellation. Three years later, she complained of epigastric pain. An intraperitoneal 3 cm mass beneath the umbilicus was showed on computed tomography (CT) scan. With the impression of gastrointestinal stromal tumor, she underwent open laparotomy at the general surgery department. A tumor was excised. Pathological examination showed that the tumor was consistent with a smooth muscle tumor of uncertain malignant potential smooth muscle tumors of uncertain malignant (STUMP). Six years postlaparoscopic myomectomy, during a regular follow-up, three parauterine masses were found on ultrasonography and CT scan. She underwent laparoscopic surgery for hysterectomy, bilateral salpingectomy, and excision of the masses. The masses were again diagnosed as STUMP. This case presents a recurrence of a rare type of smooth muscle tumor after uncontained morcellation. If myomas are to be removed with morcellation, it should only be used appropriately with a compatible containment system, and the risk of occult malignancy should be counseled.

This review aimed to evaluate the short term and long-term outcomes of laparoscopic radical hysterectomy (LRH) versus abdominal radical hysterectomy (ARH) for early-stage cervical cancer. A search of PubMed, Medline and Scopus databased from 2000 to 2018 was conducted. Thirty studies were retrieved including 22 retrospective cohort studies and 8 prospective cohort studies. LRH was comparable with ARH in 5-year overall survival (RR = 1.0. 95%CI 0.98–1.03; p = 0.33) and 5-year disease-free survival (RR = 1.02 95%CI 0.97–1.06; p = 0.98). The majority of included studies reported the negative cancer factors which drive adjuvant therapy were similar between two approaches. LRH was associated with lower blood loss and blood transfusion, less postoperative complication, shorter hospital stays and similar intraoperative complication rate compared to ARH. Our data suggested LRH for early-stage cervical cancer was as safe and effective in terms of long-term outcomes, but with lower surgical morbidities.

Abstract Background Vaginal cuff dehiscence is a rare but potentially grave complication after total hysterectomy. Abdominal or pelvic contents are at risk of evisceration through the vaginal opening. It is associated with significant risk for patient morbidity, such as peritonitis, bowel injury, and sepsis. Case presentation We report a case of vaginal cuff dehiscence in a 45-year-old multiparous Taiwanese woman who had undergone abdominal total hysterectomy and presented with vaginal cuff dehiscence precipitated by sexual intercourse. Immediate laparoscopic repair was done. Few authors have reported the utilization of the laparoscopic approach. It allows thorough inspection, visualization, and irrigation of the abdominal cavity. It is also associated with fewer intraoperative and postoperative complications. Conclusion Laparoscopic repair is a safe treatment option to manage vaginal cuff dehiscence after total hysterectomy.

We report a rare case with the late occurrence of growing teratoma syndrome (GTS). A 24-year-old woman with Grade 3 immature teratoma of ovary underwent complete surgery and chemotherapy. Nineteen years later, she developed hematuria and pelvic mass that was completely resected and pathology revealed mature cystic teratoma. She has regularly followed up with tumor marker and computed tomography every three months. No evidence of disease has been detected throughout 14 years. In addition, we present a brief review of literature of ovarian GTS in the last decade. We have found that advanced stage, high grade, or early recurrence of germ cell tumor (GCT) could be the risk factors of GTS. It tends to appear within 1 year if the patients had the incomplete resection of primary disease. We stress the importance of long-term follow-up after treatment GCT to early recognition and treatment.

A 49-year-old female had progressive diffused chest tightness for one week. Physical examination and chest film showed the right-side pneumothorax as over 40% pneumothorax. After the pneumothorax was drained by a pigtail catheter, an exploratory thoracotomy operation was conducted. The right upper lobe and pleural lesions were resected by a thoracic surgeon. The histopathology revealed emphysema of the lung, with pulmonary and pleural endometriosis. The gynecologist was consulted and laparoscopic surgery was performd for diagnosis. The endometriosis was shown at the diaphragmatic area without pelvic endometriosis. The lesions were resected. The histopathology showed endometriosis of diaphragmatic area. The five-year follow-up did not show evidence of recurrence, and hormonal treatment was not used.

A 41-year-old female, G2P2, who experienced menorrhagia for 1 month, had had a history of myoma uteri for the previous 5 years. The computed tomography showed a leiomyoma mass of approximately 8 cm. She underwent a total laparoscopic hysterectomy with bilateral salpingectomy. This pyomyoma originated in the endocervix over the cesarean section wound. The postoperative care was uneventful. Pyomyoma is a rare condition and is even rarer in premenopausal patients without a history of pregnancy or uterine instrumentation. The spontaneous pyomyoma at the endocervical leiomyoma demonstrated an unusual case in the absence of risk factors. Pyomyoma could be considered as a diagnosis in patients without fever, history of fibroids, and no other identifiable sources of infection.

Objective: Endometrial cancer in uterine anomalies is very rare. Currently, few cases with endometrial cancer coexistent with didelphys uterus are described. We present a case of a patient with carcinoma in one only horn of a didelphys uterus. Case report: A 50-year-old woman presented with abnormal uterine bleeding. Uterine anomaly was uncertain on initial clinical examination and pelvic ultrasonography. The MRI study showed double uterus and cervixes, a uterine didelphys was suspected. Preoperative histology from curettage described endometrioid adenocarcinoma. The patient underwent laparoscopic hysterectomy with surgical staging. Macroscopic examination revealed a didelphys uterus, and the final histology confirmed the diagnosis of uterine cancer. Conclusion: The coincidence of uterine malignancies and uterine anomalies is rare; however, it should be aware of uncertain diagnosis and delaying of treatment. Keywords: Endometrial carcinoma, Didelphys uterus, One horn

Objective: Glutaric aciduria type 1 is a rare disease, with the estimated prevalence about 1 in 100,000 newborns. GCDH gene mutation can lead to glutaric acid and 3- OH glutaric acid accumulation, with clinical manifestation of neuronal damage, brain atrophy, microencephalic macrocephaly, decreased coordination of swallowing, poor muscle coordination, spasticity, and severe dystonic movement disorder. Case report: A 22-year-old female, Gravida 4 Para 2, is pregnancy at 13 weeks of gestational age. Her first child is normal, however, the second child was diagnosed as glutaric aciduria type I after birth. She came to our hospital for prenatal genetic counselling of her fetus at 13 weeks of gestational age. We performed GCDH gene mutation analysis of maternal blood showed IVS 3 + 1 G > A heterozygous mutation, GCDH gene mutation analysis of paternal blood showed c. 1240 G > A heterozygous mutation, and the second child has compound heterozygous IVS 3 + 1 G > A and c. 1240 G > A mutations. Later, we performed amniocentesis at 16 weeks of gestational age for chromosome study and GCDH gene mutation analysis for the fetus. The fetal chromosome study showed normal karyotype, however, GCDH gene mutation analysis showed compound heterozygous IVS 3 + 1 G > A and c. 1240 G > A mutations. The couple decided to termination of pregnancy thereafter. Conclusion: Glutaric acidemia type 1 is an autosomal recessive disorder because of pathogenic mutations in the GCDH gene. Early diagnosis and therapy of glutaric acidemia type 1 can reduce the risk of neuronal damage and acute dystonia. We report a case of prenatal diagnosis of fetal glutaric aciduria type 1 with rare compound heterozygous GCDH gene mutation at IVS 3 + 1 G > A and c. 1240 G > A mutations, which provide better genetic counselling for the couples.

Objective: To assess the feasibility and survival outcomes of laparoscopic staging for patients with stage I ovarian cancer. Materials and methods: Consecutive patients who underwent laparoscopic staging surgery for stage I ovarian cancer from January 2002 to December 2014 were evaluated retrospectively by chart review. Results: Twenty-four patients with mean age 43.9 ± 9.9 years and mean body mass index 24.0 ± 3.8 kg/m2 were included, in which 12 (50%) patients were in stage IA and 12 (50%) in stage IC. The histological types included serous in 6 (25%), mucinous in 7 (29.1%), endometrioid in 6 (25%), clear cell in 5 (20.8%) patients. The mean surgical time was 306.4 ± 98.5 min, and the mean blood loss was 204.2 ± 188.6 mL. None of the patients required conversion to laparotomy. The median numbers of resected pelvic and para-aortic lymph nodes were 20 and 4, respectively. One (4.1%) patient encountered bowel injury intraoperatively, and the other 1 (4.1%) patient hydronephrosis postoperatively. The overall survival rate was 95% in the current series in a median follow-up of 31.5 months. Conclusion: Laparoscopic staging surgery performed for early stage ovarian cancer has better long term survival outcomes than the literature report. Laparoscopic treatment by a trained gynecologic oncologist is an ideal alternative for early stage ovarian cancer with the advantage of minimal invasiveness.

Uterine leiomyosarcoma (uLMS) is a rare and aggressive cancer, usually diagnosed incidentally at the time of myomectomy or hysterectomy. There have been concerns for several years about the fact that the inadvertent disruption of occult uLMS may have a negative impact on patient outcome. This study reviews the outcome and management of patients with a diagnosis of uLMS after surgery for presumed benign disease. We conducted a literature search in which 47 published English-language articles were obtained for evaluation. A total of 23 studies with outcomes data were included. It is evidenced that patients who underwent surgery with tumor disruption resulted in poorer outcomes compared with en bloc tumor, especially by power morcellation. The power morcellation was associated with an increased risk of recurrence, shorten time to recurrence, and upstage after re-exploration. Early re-exploration and surgical staging are appreciated for better prognosis and may alter postoperative treatment. We also updated on the incidence and preoperative evaluation to assess the risk of patient and give an effective counseling.

The introduction of newer vessel sealing systems has revolutionized techniques of hemostasis during laparoscopic surgery. These devices allow for rapid sequential tissue and vessel sealing, coagulation, and transection. Despite of widespread use of newer advanced bipolar and ultrasonic devices, monopolar and conventional bipolar electro-surgery still carry weightage due to wider range of tissue effect, dissection capabilities, cost effectiveness, and ease of availability. Here in we discussed different types of commonly available energy sources in terms of mechanism, efficacy and safety as thorough knowledge is utmost important for surgeon to choose appropriate instrument for surgical procedure. Keywords: Electrosurgery, Energy devices, Gynecology, Laparoscopy

Since Dr Dargent first reported endoscopic surgery using retroperitoneal pelvicoscopy to perform pelvic lymph node sampling in 1987, many literature reviews on the safety and feasibility of laparoscopic staging surgery of gynecologic malignancies have been published. However, the procedure of laparoscopic lymphadenectomy is more difficult to perform due to the limited surgical space and associated technical problems. Especially in the para-aortic lymphadenectomy procedure, there are many barriers to overcome in the surgical field, learning curve, and technique. We present a review of lymphadenectomy, especially para-aortic lymphadenectomy.

Objective: To present the complete history of a case with placenta accreta and demonstrate the special clues of ultrasonography finding during whole trimesters from early pregnancy to delivery. Case Report: A multiparous 28-year-old female with a history of multiple cesarean deliveries was found with suspected precesarean section scar pregnancy at 6 weeks of gestation. We performed a series of ultrasonography scans, which revealed placenta previa totalis and placenta accreta at 15 and 32 weeks of gestation, respectively. A well-planned cesarean section with hysterectomy was performed at the 35th week of gestation with massive blood transfusion support, and an alive female baby—with a birth body weight of 2485 g, and Apgar score of 9 at the 1st minute and 10 at the 5th minute—was born. The intraoperative blood loss was 7000 mL, and no postoperative hemorrhage or other complication occurred. Conclusion: Ultrasonography remains the main tool for diagnosis of morbid adherent placenta with several typical clues, including abnormal vasculature, increased size and numbers of vascular sinus, absence of uterovesicle border or retroplacental hypoechoic zone, and invaded placenta insertion on myometrium. Proper planning prior to the operation and detailed counseling may be necessary, as well as hysterectomy; massive bleeding with transfusion remained the most seen complication.

Abstract Objective To describe a case of radiation-induced uterine carcinosarcoma 6 years after a cervical squamous cell carcinoma treatment, which imposed some diagnostic and management challenges. Case Report A 57-year-old woman with a history of pelvic chemoradiotherapy ~ 6.5 years before the event described in this study, following an International Federation of Gynecology and Obstetrics (FIGO) stage IIB cervical cancer, presented with a cervical mass, involving the uterine cavity, the cervical canal and the upper two thirds of the vagina. The biopsy showed a poorly differentiated carcinoma, and a positron emission tomography (PET) scan excluded distant metastasis, although it was unable to define the origin of the tumor as either a new primary malignancy of the endometrium/cervix or as a cervical recurrence. Surgical staging procedure was performed, and the diagnosis was endometrial carcinosarcoma, FIGO stage IIB. The patient was not able to complete the adjuvant therapy, and the progression of the disease was remarkable. Conclusion The present case highlights one of the less common but more serious consequences of radiotherapy for cervical cancer, which has an increasing incidence in younger women, raising concerns about the long-termconsequences of its management.

Objective: To evaluate the incidence and prognosis of unexpected epithelial ovarian cancers (EOCs) occurring in presumed benign endometrioma. Materials and Methods: Patients who underwent primary surgery at Chang Gung Memorial Hospital between November 2003 and October 2013 were searched with the Systematized Nomenclature of Medicine code followed by chart review. Results: The incidence of unexpected EOCs in presumed ovarian endometrioma was 0.14%, as 11 patients were revealed after reviewing 497 patients of pathology-proven EOCs in the current series. All patients were aged ≥ 40 years; seven (63.6%) had inward mass within ovarian cyst in preoperative images, six had cancer antigen-125 (CA-125) > 200 U/mL, and two with CA-125 > 1500 U/mL. Ten patients underwent laparoscopy initially, including five with ovarian preservation at the beginning. Ten patients subsequently completed concurrent or secondary staging surgery, including four totally with laparoscopy. The histologic subtypes had clear-cell (8/11), endometrioid (1/11), mixed clear-cell and endometrioid (1/11), and low-grade serous adenocarcinoma (1/11). Seven patients had endometriosis-associated ovarian carcinoma (EAOC), while the other four were non-EAOC with no endometriosis component. The only mortality was a patient of non-EAOC in Stage IIIc, whereas the other 10 in Stage I were alive. The overall survival rate was 90.9% (10/11) with follow-up ranging from 23 months to 130 months. Conclusion: Unexpected EOCs occurring in presumed ovarian endometrioma was rare and, if present, the prognosis was good in Stage I disease with laparoscopic management. Combining parameters of patient's age, CA-125 level, and inward solid mass at imaging could help to raise the precautions.

Although the incidence of most cancers increases with age, a considerable number of patients receive a diagnosis of cancer during their reproductive years. Young women wishing to get pregnant after cancer treatment should be provided consultation for fertility preservation and possible options. In patients with cervical cancer, hysterectomy is often inevitable because the uterus is located too close to the cervix. For young patients with cervical cancer who desire to get pregnant and whose lesion is confined to the cervix, sparing the uterus and, partially, the cervix should be prioritized as much as possible, while simultaneously ensuring favorable oncologic outcomes. In this review, we explore how to choose an adequate fertility-preserving procedure to achieve a balance between favorable oncologic outcomes and fertility and management during pregnancy after a radical trachelectomy in women with early-stage cervical cancer. For patients who require hysterectomy or radiation, evaluation of the ovarian condition and laparoscopic ovarian transposition followed by the use of artificial reproduction techniques and pregnancy by surrogacy should be discussed as options to achieve a successful pregnancy. [ABSTRACT FROM AUTHOR]

Under-utilization of Papanicolaou (Pap) smear causes a gap in the prevention of cervical neoplasms. A prospective population-based study was conducted investigating whether a self-sampling human papillomavirus (HPV) test was feasible for under-users of Pap smear and factors associated with under-screening in Taiwan. Methods: Women not having Pap smear screening for > 5 years were invited to participate in this study. Invitation letters and educational brochures were mailed to 4% of randomly selected eligible women from Taoyuan City, Taiwan, and responders received an HPV self-sampling kit. Those with HPV-positive results were recalled for a Pap smear and colposcopy. Results: Between March 2010 and June 2012, 10,693 women were invited, 354 responded (3.3%), and 282 (2.6%) gave valid informed consent, answered the questionnaire, and submitted HPV samples. The median age of enrolled women was 48.1 years. Forty-seven women (16.7%) had a positive HPV test, and 14 women accepted further survey to find two CIN2+. Another two cases of CIN2+ were identified from a national registry database. The cost of direct mailing self-samplers was less than that done on request (from NT$434,866 to NT$164,229, response rate of 5% to 15%, respectively, versus NT$683,957 for detecting 1 CIN2+). Reasons for not attending screening included lack of time, embarrassment, assumed low risk, fear of positive results, and perceived potential pain. Among the responders, 90.8% found the method acceptable. Conclusion: Our study indicated that different approaches (e.g., direct mailing self-samplers to under-users and/or various educational interventions) must be explored to improve coverage in populations with culture characteristics similar to Taiwan.

Objective: To establish a specific hysteroscopic pattern–the “glomerular pattern”–to diagnose high-grade endometrial cancer and evaluate the accuracy rate of the pattern, based on final histology. Materials and methods: From 2008 to 2011, 30 patients for whom pathology indicated endometrial cancer, based on the office hysteroscopy study, were included in the study. We reviewed the hysteroscopic pictures to determine the specific hysteroscopic pattern in high-grade endometrial cancer. Results: Thirty patients who had endometrial cancer under hysteroscopy were included to the study. The study population had a mean age of 49.9 years. All patients had abnormal uterine bleeding. Office hysteroscopy was completed in all patients without anesthesia. The findings of the office hysteroscopy suggested endometrial cancer in 30 patients. Fifteen patients had the specific hysteroscopic pattern, called the “glomerular pattern.” All 15 patients had grade 2 or grade 3 disease. Among patients who had a glomerular pattern, 53.3% (8/15) of patients had grade 2 endometrioid adenocarcinoma and 46.7% (7/15) patients had grade 3 endometrioid adenocarcinoma. Among the nonglomerular pattern group patients, 66.7% (10/15) patients had grade 1 endometrioid adenocarcinoma, 26.7% (4/15) patients had grade 2 endometrioid adenocarcinoma and 6.7% (1/15) patients had grade 3 endometrioid adenocarcinoma. Conclusion: Our conclusion is that patients with the glomerular pattern have a high percentage of moderate or high-grade endometrioid adenocarcinoma. The glomerular sign may provide information on preoperative pathohistology and decrease the possibility of histology upgrade after hysterectomy. However, large series, prospective, and comparison studies are still needed.

Objective: To assess the long-term outcomes of laparoscopic staging surgery (LSS) in treating patients with endometrial carcinoma. Materials and Methods: Patients with endometrial cancer who underwent LSS between June 1995 and June 2014 were prospectively registered. Perioperative data, complications, disease recurrence, and long-term survival were measured. Results: The study included 287 consecutive patients [mean age (± standard deviation), 53 ± 10.4 years; mean body mass index, 27.3 ± 6.7 kg/m2] with a median follow-up ranging from 1 to 216 months. No laparotomy conversion was recorded for any patient. The mean operative time was 207 ± 63.5 minutes, and the mean blood loss was 183 ± 166.7 mL. The mean numbers of pelvic nodes and para-aortic nodes removed were 18 ± 4.8 and 8 ± 5, respectively. More than 80% of the patients had an International Federation of Gynecology and Obstetrics (FIGO) Stage 1 disease. The overall complication rate was 3.1%, including two patients of bladder injuries and one with bowel injury intraoperatively, and postoperatively one patient with pelvic abscess, three with urinary tract infection, one with voiding difficulty, and one with bowel perforation. The overall survival rates were 94% in 5 years and 92.7% in 20 years. No port-site metastasis was recorded in this study. Conclusions: Patients with endometrial carcinoma treated by LSS had compatible or even better long-term survival outcomes and less complication in comparison with the published data, in addition to the benefits of its minimally invasive characteristics. LSS should be the treatment of choice for endometrial cancer.

Objective: Term pregnancy with choriocarcinoma is a rare condition that can be a serious health threat to both the mother and the fetus. We present a rare case of term pregnancy with choriocarcinoma presenting as severe fetal anemia and postpartum hemorrhage. Case Report: A 34-year-old woman, gravida 3 para 2, was admitted for profuse vaginal bleeding 2 weeks after cesarean delivery of a full-term anemic baby. Transvaginal sonography revealed a 4.7-cm × 10.6-cm heterogenous lesion in the endometrial cavity. Dilatation and curettage was done and a pathologic report revealed choriocarcinoma. Metastatic workup showed lung metastasis. The patient achieved remission after eight cycles of chemotherapy in the form of etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine. There was no evidence of recurrence in the subsequent 3 years of regular follow up. Conclusion: Although fetomaternal hemorrhage is a rare form of presentation of choriocarcinoma, its presence should alert the physician to investigate the cause further. This chemotherapy regimen was effective in our case and the patient needed to be followed up carefully.

Objective: There are some reports of cervical cancer with uterus didelphys but a case of clear cell carcinoma (CCCC) with Obstructed Hemivagina and Ipsilateral Renal Anomaly (OHVIRA) syndrome is extremely rare. The aim of this paper was to report a case of CCCC with OHVIRA syndrome and the difficulty in making a preoperative diagnosis. Case report: A 65 years old woman presented with postmenopausal bleeding and pelvic examination showed right paracervical mass. Preoperative confirmation of cervical carcinoma was difficult due to the location of the mass, which was inaccessible by cervical punch biopsy. Pelvic examination revealed a large mass in pelvic cavity without parametrial invasion and ultrasound showed approximately 70 mm cervical tumor. Laparoscopic surgery revealed clear cell carcinoma of the para-endocervix with OHVIRA syndrome. Conclusion: In the case of cervical carcinoma with OHVIRA syndrome, laparoscopic surgery is preferable for the diagnosis and management.

The objective of the study is to report on the unusual case of an elongated endometrial polyp prolapsing through the introitus. A nulliparous 38-year-old woman presented to the gynecology department with an abnormal mass prolapsing at the vulva area without any abnormal uterine bleeding. Because she had no history of having engaged in sexual intercourse, a pelvic examination was not performed. Ultrasonography revealed an intrauterine hyperechoic lesion 1.5 cm × 0.8 cm in diameter suspected to be endometrial polyp. A hysteroscopy revealed an elongated endometrial polyp 12 cm × 0.5 cm in length, which originated from the midanterior corpus and extended out of the cervix and introitus. Then, the base of the polyp was cut and removed. The pathological report was consistent with an endometrial polyp. This was an unusual case of an elongated endometrial polyp prolapsing through the introitus in a nulliparous woman. Hysteroscopy is the best tool for diagnosis and management in this case.

Despite the low frequency, port-site metastases are associated with poor outcomes in patients and account for significant patient morbidity. They remain a challenging complication of laparoscopic procedures for gynecologic malignancies. A comprehensive, systematic search for published studies was conducted using the PubMed databases. Various mechanisms of port-site metastases are addressed in the relevant literature. The review of the articles points out that in the development of port-site metastases, the major role is played by biologically aggressive diseases, tumor manipulation, wound contamination, and surgery-related factors. The advantages of laparoscopic oncologic surgery are unquestionable. Further investigations of the mechanisms of port-site metastasis would contribute to the prevention of this insidious pathology.

Objective: To compare the methods of transcervical resectoscopy versus dilation and curettage (D&C) for endometrial biopsy and to compare these methods for the percentage of histological upgrades at the final posthysterectomy pathology findings in endometrial cancer. Materials and methods: We retrospectively reviewed 253 cases of uterine cancer diagnosed from May 1995 to January 2014. Included in the study were patients who received transcervical resectoscopy (TCR) or D&C biopsy as the diagnostic method and underwent laparoscopic staging at our institution. The International Federation of Gynecologists and Obstetricians (FIGO) grade in the pathological report of the biopsy and final hysterectomy were recorded. The extrauterine risk was stratified using the initial FIGO grade and depth of myometrium invasion. It was compared to the actual risk using final pathological findings. Results: We identified 203 cases of endometrial cancer; 18 (8.9%) patients had a higher histological grade at the final hysterectomy. Among the 203 patients, 76 patients underwent TCR biopsy and 127 underwent D&C biopsy. The histological grade was upgraded in two (2.6%) patients in the TCR group. Three (3.9%) patients had positive peritoneal washings. In the D&C group, 16 (12.6%) patients with three (2.4%) positive peritoneal washings were upgraded. Conclusion: Transcervical resectoscopy could provide more precise grading information, compared to D&C (2.6% vs. 12.6%). Doctors could therefore make a more accurate staging plan, based on the preoperative risk evaluation.

A case of a 32‑year‑old patient who presented with vaginal bleeding 2 years after undergoing laparoscopic radical trachelectomy and vaginal cerclage was noted to have Mersilene tape erosion. Subsequent management includes the removal of displaced Mersilene tape and a repeat cerclage through a new technique of laparoscopic abdominal cerclage to avoid repeat tape erosion. The novel technique of laparoscopic abdominal cerclage to lower the incidence of preterm delivery among pregnant patients who underwent laparoscopic radical trachelectomy for early-stage cervical cancer is described. [ABSTRACT FROM AUTHOR]

Objective: A twin pregnancy consisting of a complete hydatidiform mole with a coexisting normal fetus is extremely rare with an incidence of 1/22,000 to 1/100,000. The incidence of preterm delivery is high and few pregnancies reach near term with a viable fetus. Case report: A 34-year-old woman presented at 20 weeks of gestation with increased levels of serum beta human chorionic gonadotropin (beta-HCG) at 4.74 multiples of the median (310277.7 mIU/mL). Ultrasonography showed a hydatidiform mole together with a normal fetus. Fetal karyotyping revealed 46XY. The serum beta-HCG levels were followed up throughout the remainder of the pregnancy. A male infant weighting 2260 g and the molar tissue were delivered at 37 weeks of gestation. The karyotype of the molar tissue showed 46XX and the histopathological report confirmed our diagnosis. At 4 months postpartum, metastatic gestational trophoblastic disease of the lung was diagnosed in the mother by a computed tomography scan due to increased beta-HCG levels. The patient received three unsuccessful cycles of methotrexate and folinate. Another four cycles of chemotherapy consisting of etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine (EMA-CO) were initiated and the beta-HCG levels returned to normal. There was no evidence of recurrence in the subsequent 5 years of regular follow up. Conclusion: A pregnancy with a complete hydatidiform mole and a living cotwin can be a serious threat to the health of both the mother and the fetus. Early diagnosis depends on a combination of detecting an unusually high level of serum beta-HCG and ultrasound examination. We suggest that continuation of the pregnancy may be an acceptable option and that the pregnancy may continue until term if a normal fetal anatomy is assured and maternal complications are under control. Patients require careful postpartum follow up and any recurrent disease should be managed aggressively.

Objective: This study was conducted to describe the feasibility of treating endometrial cancer with hysterectomy, bilateral salpingo-oophorectomy, and bilateral pelvic lymphadenectomy by natural orifice transluminal endoscopic surgery (NOTES). Methods: Women with early-stage endometrial cancer underwent surgical staging by transvaginal NOTES in a tertiary referral medical center, and surgical outcomes were measured. Results: Three patients with a mean age of 46.3 [standard deviation (SD) = 2.5] years and a body mass index of 27.7 (SD, 2.4) kg/m2 were selected. The average operative time was 249.3 (SD, 49.3) minutes. All patients had minimal blood loss during the operation (

Objective: This study aims to evaluate the long-term safety and efficacy of laparoscopic staging surgery (LSS) for endometrial cancer in Taiwanese women. Materials and Methods: This is a longitudinal study of prospectively registered 105 patients who underwent LSS for endometrial cancer between June 1995 and June 2008. Results: The mean duration of surgery was 186.8 minutes, and the mean intraoperative blood loss was 220.38 mL. The median number of retrieved pelvic lymph nodes was 18. The intraoperative complication rate was 4.8%, including two cases of ureteral injury and one case each of bladder injury, bowel injury, and vascular injury. No patient required conversion to laparotomy. During the median follow-up of 55.3 months, six cases of recurrence (5.7%) and three tumor-related deaths (2.9%) were recorded. The 5-year disease-free survival and the overall survival were 93.39% and 98.05%, respectively. Conclusion: The study revealed favorable perioperative outcomes and better long-term survival than reported in the Taiwan Cancer Registry, and similar good surgical results to those reported in the Western studies. Therefore, LSS by experienced surgeons for endometrial cancer is a feasible and efficacious alternative to laparotomy.

Objective: The purpose of this article is to describe the application of hysteroscopy in different cases of gestational trophoblastic disease. Materials and methods: Three patients who presented with gestational trophoblastic disease were managed with hysteroscopy. The first case was a hydatidiform mole that underwent transcervical resection with endometrial curettage. The second case had a history of suction curettage for hydatidiform mole. She underwent transcervical resection for retained products of conception. The third case had a history of suction curettage for hydatidiform mole. In contrast with the second case, the patient had rising β human chorionic gonadotropin (β-HCG) values prior to transcervical resection and eventually underwent chemotherapy in the form of methotrexate. Results: The surgical procedure was uneventful in all three patients. All three operations were performed in