Details of a Researcher - TAMATE MASATO

Papers - TAMATE MASATO

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Outcome and Surgical Technique of Robot-assisted Living Donor Hysterectomy for Uterus Transplantation.

Masato Tamate, Giuliano Testa, Laura Divine, Liza Johannesson

Journal of minimally invasive gynecology 2025.03 [International journal]

DOI PubMed

Standardization of back-table technique for uterus transplantation.

Masato Tamate, Giuliano Testa, Johanna Bayer, Liza Johannesson

Fertility and sterility 2025.02 [International journal]

OBJECTIVE: To present a standardized back-table technique for uterus transplantation (UTx). DESIGN: Step-by-step description of surgical technique and live-action narrated surgical footage showing back-table technique in UTx. SUBJECTS: Uterus transplantation has become a viable option for patients with absolute uterine factor infertility and their families. After performing 20 research cases, our institution has conducted UTx in 13 patients, and over 100 cases have been performed worldwide. Uterus transplantation is now considered technically feasible, with a high live birth rate after successful graft survival. INTERVENTION: The transplantation of a uterus involves three separate surgical components: living or deceased uterus retrieval; back-table preparation of the uterine graft; and implantation of the uterine graft in the recipient. The living donor hysterectomy and implantation of the uterus in the recipient can be seen in separate videos. The back-table process is critically important in transplant surgery. After the uterus is removed from the donor, organ perfusion, vascular preparation, and marking are essential for ensuring a smooth transition to recipient surgery. In this video, we demonstrate our standardized back-table technique. Currently, there are no articles in gynecology focused solely on back-table techniques. When selecting a potential donor, factors such as age, body mass index, general health, and obstetric and surgical history are considered. Once a candidate is deemed suitable, in-person screening includes blood tests, imaging studies, and mental health evaluations. Preoperative imaging provides valuable information on the condition of the uterine vascularity, which is crucial given the complexity and variability of pelvic vessels. Once the uterus is removed from a living or deceased donor, it is immediately placed on ice and flushed with cool preservation fluid on the back-table. Back-table procedures average 0.5-1 hours and includes the following: perfusion; preparation of the arteries; preparation of the veins; ligation of the base of the fallopian tubes; and four-point suturing of the vagina, as well as (optional) cervical cerclage. Preparing the veins is a key part of the back-table process, especially when the vessel diameters are small, necessitating conjoining. Additionally, because the uterus is a mobile organ located between the bladder and rectum, it is essential to assess the shape and positioning of the vessels that will be anastomosed to avoid torsion during the uterine-vessel anastomosis. We believe that our method will be useful for many institutions that wish to initiate UTx programs. MAIN OUTCOME MEASURES: Uterine graft viability and recipient pregnancy outcome. RESULTS: No surgical complications occurred. The postoperative course was uneventful, with early mobilization. The length of hospital stay was 5 days. The uterus was successfully implanted with successful pregnancy outcome. CONCLUSION: Our standardized back-table technique minimizes harm to the recipient. Furthermore, the technique does not compromise the uterine graft function. Further studies and more educational content using video will be key to the widespread adoption of uterine transplantation.

DOI PubMed

Standardization of recipient surgery for uterus transplantation.

Masato Tamate, Liza Johannesson, Johanna Bayer, Giuliano Testa

Fertility and sterility 2025.02 [International journal]

OBJECTIVE(S): To present a standardized surgical technique of recipient transplant surgery for uterus transplantation (UTx). DESIGN(S): Step-by-step description of surgical technique and live-action narrated surgical footage showing uterus recipient surgery in UTx. SUBJECT(S): Uterus transplantation can become a standard option for patients with absolute uterine factor infertility and their families (1, 2). Thirty-six uterus cases of UTx have been performed at Baylor University Medical Center in Dallas (January 2025). Most uterus recipients to date have a congenital absence of the uterus (Mayer-Rokitansky-Küster-Hauser syndrome [MRKH]). Our team has established standard methods for donor surgery and uterine graft back-table techniques. Because the uterus recipient surgery is typically performed using an open approach, high-quality educational videos of UTx are scarce. To aid institutions interested in initiating UTx, an educational video demonstrating our standardized recipient surgery is essential. This video shows the surgical procedure in a 39-year-old previously healthy woman with MRKH. The vascular nomenclature recommended by the United States Uterus Transplant Consortium is used in the manuscript (3). INTERVENTION(S): Uterus transplant recipient surgeries are performed via laparotomy and are significantly shorter than the living donor hysterectomies, averaging 4-5 hours (4). The operative steps performed are as follows: 1) exposure of the external iliac vessels; 2) exposure of the vaginal anastomosis site; 3) graft implantation and vascular anastomosis; 4) vaginal transection and anastomosis; and 5) fixation of the uterus and ovaries. Steps 1-2 are performed jointly by the gynecology surgeon and transplant surgeon; step 3, involving the anastomosis of blood vessels, is conducted by the transplant surgeon. Although steps 1, 2, 4, and 5 are not particularly challenging for an experienced gynecologic oncology surgeon, the vascular anastomosis in step 3 is delicate. This anastomosis involves suturing blood vessels smaller than those used in kidney and liver transplants, using 7-0 monofilament for the arterial and 8-0 monofilament for the venous anastomosis. After reperfusion of the uterine graft, the vaginal anastomosis is completed, which is where most of the bleeding occurs during surgery. For this step (step 4), we use continuous suturing from the 3 to 9 o'clock positions. The vaginal approach is preferred because of the challenging anatomy, particularly in patients with MRKH, where the foreshortened vagina lies deep in the pelvis. Continuous sutures are used for hemostasis in the posterior vaginal wall, where venous blood flow is abundant. To attempt prevention of vaginal structuring, the anterior vaginal wall is sutured interrupted. Step 5 includes fixation of the uterus and ovaries. A trained gynecology surgeon is essential, because the technique may vary depending on the condition of the patient with MRKH. Before implantation of the uterine graft in the recipient, the uterus is removed from a living or deceased donor and subsequently placed on ice and flushed with cool preservation fluid on the back table. The back table is a sterile area used in transplantation surgery where the organ is prepared for transplantation. Preparation includes trimming and potential 86 reconstructions of the vessels that will be used. The living donor hysterectomy and the back table procedure can be seen in separate videos. MAIN OUTCOME MEASURE(S): Hospital stay, perioperative, and long-term complications. Uterine graft viability and recipient pregnancy outcome. RESULT (S): No surgical complications occurred. The postoperative course was uneventful, with early mobilization. The length of hospital stay was 5 days. The uterus was successfully implanted with a successful pregnancy outcome. CONCLUSION(S): Our standardized uterus recipient surgery technique minimizes harm to the recipient. Furthermore, the technique does not compromise the uterine graft function and pregnancy outcome. Further studies and more educational content using video will be key to the widespread adoption of uterine transplantation.

DOI PubMed

Standardization of robot-assisted living donor hysterectomy for uterus transplantation.

Masato Tamate, Laura Divine, Giuliano Testa, Liza Johannesson

Fertility and sterility 2025.02 [International journal]

OBJECTIVE: To present a standardized surgical technique of robot-assisted living donor hysterectomy for uterus transplantation with preservation of the donor ovaries. DESIGN: Step-by-step description of surgical technique and live-action narrated surgical footage showing uterus donor hysterectomy. SUBJECTS: Nineteen robot-assisted living donor hysterectomies for uterus transplantation have been performed at Baylor University Medical Center at Dallas (September 2024). This video shows the surgical procedure in a 33-year-old previously healthy woman. She had a history of a unilateral laparoscopic ovarian cystectomy, and her obstetric history included three term vaginal deliveries. She independently contacted our institution expressing interest in becoming a nondirected uterus donor and underwent comprehensive evaluation by a multidisciplinary transplant team, including medical and psychological assessment for suitability to donate. She explicitly stated desire for no further children. INTERVENTION: Robot-assisted living donor hysterectomy using the da Vinci Xi robotic system. Surgery was performed with the patient in Trendelenburg position (15°), using CO2 pneumoperitoneum (<12 mm Hg), with a four robotic-arm arrangement. Ureteric stents were placed bilaterally, and indocyanine green was injected retrograde to facilitate ureter identification using firefly mode during dissection. Retraction of the uterus was performed with a uterine manipulator. The operative steps performed were as follows: ligation of the round ligaments and exposure of the retroperitoneal space; dissection of the superior uterine veins; dissection of the uterine arteries and the inferior uterine veins; dissection of the ureters, bladder, and rectum; vaginotomy and transection of the vessels; transvaginal uterine graft extraction using a Endo Catch retrieval system and closure of the vaginal cuff. Anatomical terms are used in the video and narration with reference to common gynecological practice. After removal of the uterus from the donor, the uterus was placed on ice on the back-table and flushed with cool preservation fluid. The back-table is a sterile area used in transplantation surgery where the organ is prepared for transplantation. Preparation includes trimming and potential reconstruction of the vessels that will be used. It is on the back-table where the final decision to go ahead with the transplant surgery is made by the uterus transplant team. The back-table procedure and implantation surgery can be seen in separate videos. MAIN OUTCOME MEASURES: Hospital stay, perioperative and long-term complications, uterine graft viability, and recipient pregnancy outcome. RESULTS: No surgical complications occurred. The postoperative course was uneventful, with early mobilization. The length of hospital stay was 2 days. At a 1-year follow-up, the donor reported no concerns and sexual activity without complications. The uterus was successfully implanted to a recipient with successful pregnancy outcome. CONCLUSION: Our standardized robot-assisted living donor hysterectomy technique represents a safe approach to minimize donor harm and allows for preservation of the donor ovaries. Furthermore, the technique does not compromise the uterine graft function and pregnancy outcome.

DOI PubMed

Human papillomavirus self-sampling and urine-sampling tests and the management and short-term outcomes of cervical intraepithelial neoplasia: A prospective observational study.

Motoki Matsuura, Masato Tamate, Sachiko Nagao, Taishi Akimoto, Fukiko Kasuga, Kimihito Saito, Satoshi Shikanai, Yoko Nishimura, Mizue Teramoto, Tsuyoshi Saito

The journal of obstetrics and gynaecology research 50 ( 10 ) 1801 - 1807 2024.10 [International journal]

AIM: The importance of human papillomavirus (HPV) co-testing using physician-, self-, and urine-collected samples to predict cervical intraepithelial neoplasia (CIN) grade 1-2 prognoses has not been previously reported. Therefore, this study aimed to investigate outcomes of patients with CIN 1-2 who simultaneously underwent physician-, self-, and urine-collection sampling tests. METHODS: This study was conducted in Japan between October 2019 and November 2022 and examined the proportion of cases with CIN 1-2 progressions, the percentage of cases with persistent CIN 1-2, and the outcome differences according to the results of physician-, self-, and urine-sampling tests. RESULTS: There were 105 and 59 CIN 1 and 2 cases, respectively, with progression or persistence in 27 (29.3%) and 21 (50.0%) cases, respectively. The median follow-up was 20 and 12 months, respectively. Progression and persistence of CIN 1 were significantly associated with HPV-positive physician- and self-collected samples. No significant difference was observed between cases with CIN 2 who had HPV-positive and HPV-negative results using any sampling method. CONCLUSIONS: Physician- and self-testing for HPV are crucial for predicting disease progression risk in CIN 1 cases. Future research with an extended observation period and consideration of the progression risks is warranted.

DOI PubMed

Successful Outcome of Stage IB3 Cervical Cancer Treated With Neoadjuvant Chemotherapy Followed by Vaginal Radical Trachelectomy: A Case Report.

Masato Tamate, Motoki Matsuura, Masayuki Someya, Tasuku Mariya, Shinichi Ishioka, Tsuyoshi Saito

Cureus 16 ( 10 ) e71626 2024.10 [International journal]

Vaginal trachelectomy, which involves resecting the cervix and its parametrium, is a fertility-sparing option for the treatment of early-stage cervical cancer. Although no consensus has been reached on whether simple or radical trachelectomy is preferable, the vaginal approach is typically avoided for tumors larger than 2 cm due to concerns about recurrence. However, some evidence suggests that fertility preservation may still be viable for select patients with larger tumors. This case report describes a woman with bulky cervical cancer who wished to preserve her fertility. After undergoing neoadjuvant chemotherapy (NAC) and vaginal radical trachelectomy (VRT), she achieved a favorable oncological and perinatal outcome, successfully giving birth to a near-full-term baby. The report outlines the patient's management before, during, and after the procedure, including perinatal care. While careful selection of candidates is crucial, accumulating case reports and future trials are expected to shed more light on this treatment approach.

DOI PubMed

Risk-reducing salpingo-oophorectomy for hereditary breast and ovarian cancer patients with vaginal natural orifice transluminal endoscopic surgery (vNOTES).

Masato Tamate, Motoki Matsuura, Sachiko Nagao, Shoko Kurokawa, Taishi Akimoto, Tsuyoshi Saito

International journal of gynecological cancer : official journal of the International Gynecological Cancer Society 2024.09 [International journal]

DOI PubMed

Step-by-step demonstration of "sciatic-nerve-preserved beyond-LEER" in a Thiel-embalmed cadaver: a novel salvage surgery for recurrent gynecologic malignancies.

Hiroyuki Kanao, Masato Tamate, Motoki Matsuura, Sachiko Nagao, Miseon Nakazawa, Shutaro Habata, Tsuyoshi Saito

Journal of gynecologic oncology 35 ( 5 ) e112 2024.09 [International journal]

OBJECTIVE: Complete resection is the curative treatment choice for recurrent gynecological malignancies. Laterally extended endopelvic resection (LEER) is an effective surgical salvage therapy for lateral recurrence. However, when a recurrent tumor occupies the ischial spine and sacrum, LEER is not indicated, and surgical salvage therapy is abandoned. Theoretically, complete resection of such a tumor is possible by additional pelvic bone resection along with the standard LEER. Nevertheless, owing to the anatomical complexities of the beyond-LEER procedure, 2 major issues should be solved: sciatic nerve injury and tumor disruption during pelvic bone amputation. To overcome these technical challenges, we applied a multidirectional beyond-LEER approach, a novel salvage surgical procedure, with an aim of demonstrating its technical feasibility. METHODS: We created a simulation model of a laterally recurrent tumor that occupied the right ischial spine and sacrum in a Thiel-embalmed cadaver. RESULTS: Multidirectional approaches, including laparoscopic, perineal, and dorsal phases, were safely applied. We laparoscopically marked the L4-L5-S1 complex and S2 nerve with different colored tapes, and by pulling them out into a dorsal surgical field, the sciatic nerve was safely preserved. The dissection lines of the multidirectional approaches were aligned using tapes as landmarks, and complete tumor clearance without tumor disruption was accomplished. By following the cadaveric training, the first laparoscopic-assisted beyond-LEER procedure was successfully performed in a patient with recurrent ovarian cancer. CONCLUSION: Using a Thiel-embalmed cadaver, we demonstrated the technical feasibility of a sciatic nerve-preserved beyond-LEER procedure, which was successfully performed in a patient with recurrent ovarian cancer.

DOI PubMed

当院における類内膜癌G3症例の細胞診・病理形態学的評価と臨床経過の検討

幅田周太朗, 齋藤晋平, 有元千紘, 野藤五沙, 長尾沙智子, 黒川晶子, 玉手雅人, 真里谷奨, 秋元太志, 松浦基樹, 岩崎雅宏, 齋藤豪

日本婦人科腫瘍学会学術講演会プログラム・抄録集 ( (公社)日本婦人科腫瘍学会 ) 66回 327 - 327 2024.07

当院における類内膜癌G3症例の細胞診・病理形態学的評価と臨床経過の検討

幅田周太朗, 齋藤晋平, 有元千紘, 野藤五沙, 長尾沙智子, 黒川晶子, 玉手雅人, 真里谷奨, 秋元太志, 松浦基樹, 岩崎雅宏, 齋藤豪

日本婦人科腫瘍学会学術講演会プログラム・抄録集 ( (公社)日本婦人科腫瘍学会 ) 66回 327 - 327 2024.07

Early outcomes of three new robotic surgical systems in patients undergoing hysterectomy.

Motoki Matsuura, Sachiko Nagao, Shoko Kurokawa, Masato Tamate, Taishi Akimoto, Tsuyoshi Saito

Updates in surgery 76 ( 5 ) 2051 - 2057 2024.05 [International journal]

New robot models, such as hinotori™, da Vinci SP™, and Hugo™, have been introduced in Japan. This study examined the surgical outcomes of these models in patients from the initial stages of their introduction to the present day.We retrospectively reviewed 36 patients with endometrial cancer or benign gynecologic disease, who underwent robotic hysterectomy using da Vinci SP™, hinotori™, or Hugo™ between March 2023 and March 2024.Robotic hysterectomy was performed using hinotori™ in 10 patients, da Vinci SP™ in 16 patients, and Hugo™ in 10 patients. No significant differences were observed in the characteristics of the patients subjected to surgery using these models. The total operative time was 123.0 min (93-144 min) for hinotori™, 95.0 min (79-165 min) for da Vinci SP™, and 98.5 min (74-177 min) for Hugo™. The total operative time of hinotori™ was significantly longer than that of the other two models (p = 0.031). No differences were observed among the robot systems with respect to complications during or after surgery and the intensity of postoperative pain.Differences in the surgical time were noted depending on the model used. It has been proven that surgeons who are already proficient in performing robotic surgery with da Vinci Xi™ can safely perform surgeries with the new models.

DOI PubMed

Surgical Outcomes of da Vinci Xi™ and da Vinci SP™ for Early-Stage Endometrial Cancer in Patients Undergoing Hysterectomy.

Motoki Matsuura, Sachiko Nagao, Shoko Kurokawa, Masato Tamate, Taishi Akimoto, Tsuyoshi Saito

Journal of clinical medicine 13 ( 10 ) 2024.05 [International journal]

Objectives: This study aimed to evaluate and compare the feasibility and outcomes of two robotic hysterectomy (da Vinci Xi™ vs. da Vinci SP™) systems without lymph node dissection in patients with early-stage endometrial cancer, and assess the postoperative recurrence rate and overall survival of patients. Methods: A retrospective review of 84 patients who underwent robotic hysterectomy for endometrial cancer (stage 1A) was conducted. Surgical procedures, patient characteristics, intraoperative measures, and postoperative outcomes were statistically analyzed. A single gynecologist performed all surgeries. Results: Patient characteristics, average age, and body mass index showed no significant differences between the two models. The total operative time was significantly shorter with da Vinci SP™. Recurrence was identified in only one patient operated on with da Vinci Xi™. All patients were alive during analysis, with a median overall survival of 38 and 9 months for da Vinci Xi™ and da Vinci SP™, respectively. Conclusions: Robotic hysterectomy without lymph node dissection appears to be a safe and effective approach for patients with early-stage endometrial cancer. The da Vinci SP offers the advantage of shorter operative times than the da Vinci Xi™. These findings support the consideration of robotic surgery as a viable option for selected patients.

DOI PubMed

Current treatment strategies for ovarian cancer in the East Asian Gynecologic Oncology Trial Group (EAGOT).

Yusuke Kobayashi, Muneaki Shimada, Masato Tamate, Hyun Woong Cho, Jun Zhu, Hung-Hsueh Chou, Hiroaki Kajiyama, Aikou Okamoto, Daisuke Aoki, Sokbom Kang, Jeong-Won Lee, Jae-Weon Kim, Jae-Hoon Kim, Zhongqiu Lin, Jihong Liu, Xiaohua Wu, Hung-Cheng Lai, Ting-Chang Chang, Chyong-Huey Lai, Yong Man Kim, Takayuki Enomoto

Journal of gynecologic oncology 35 ( 3 ) e87 2024.05 [International journal]

Ovarian cancer, notable for its severe prognosis among gynecologic cancers, has seen substantial progress in treatment approaches recently. Enhanced protocols in chemotherapy and the introduction of poly (ADP-ribose) polymerase (PARP) inhibitors for maintenance therapy have markedly improved outcomes for patients with specific genetic profiles, such as those positive for BRCA mutations or exhibiting homologous recombination deficiency (HRD). Additionally, the method of intraperitoneal chemotherapy administration has emerged as a valuable alternative to traditional transvenous routes, showing promise for wider clinical adoption. The field of surgery has also evolved, with increasing exploration into the benefits and feasibility of laparoscopic methods over more invasive traditional surgeries, aiming for complete tumor removal but with reduced patient impact. The hereditary nature of ovarian cancer underscores the importance of genetic testing, which has become integral in tailoring treatment strategies, particularly in determining suitability for PARP inhibitors. The formation of the East Asian Gynecologic Oncology Trial Group (EAGOT) aims to optimize treatment across Japan, Korea, China, and Taiwan. The ovarian cancer committee of EAGOT shared the current policies, focusing on 5 topics: 1) strategies for maintenance therapy after initial surgery and chemotherapy, 2) drug regimens for platinum-sensitive and platinum-resistant recurrence, 3) intraperitoneal chemotherapy, 4) laparoscopic surgery as an alternative to laparotomy, and 5) current status of genetic testing (BRCA, HRD, and panel tests) for ovarian cancer and its prospects. EAGOT's multi-national trials aim to harmonize these evolving treatment strategies, ensuring that the latest and most effective protocols are accessible across the region, thereby significantly impacting patient outcomes in East Asia.

DOI PubMed

Hybrid Train-The-Trainer course for the Fundamental Use of Surgical Energy certificates improves self-confidence in knowledge of surgical energy and develops teaching skills: a feasibility study.

Akihiro Kondo, Masato Tamate, Yuichi Nishihara, Yusuke Watanabe

Surgical endoscopy 38 ( 1 ) 368 - 376 2024.01 [International journal]

BACKGROUND: Several well-trained expert instructors who completed the "Train-The-Trainer (TTT)" course are required to disseminate the safe use of surgical energy devices, which can be learned through the Fundamental Use of Surgical Energy (FUSE) program. This study aimed to explore whether the hybrid FUSE TTT course is feasible and effective, which can improve teaching skills of surgical energy. METHODS: The hybrid TTT course, which was designed to train FUSE-certified personnel as instructors, comprised three virtual sessions spread over 5 h in total and a 1-day in-person training, followed by a 100-min FUSE electrosurgery hands-on workshop in practice as an instructor. The participants reported on self-confidence regarding knowledge of various energy devices or adverse events before, immediately after, and 6 months after the course. Participants and experienced FUSE instructors assessed the trainees' presentation skills at the beginning of the in-person training and after the hands-on workshop. The primary outcomes were the feasibility and completion rate of the entire course. RESULTS: Seventeen participants completed the entire couse; most (94%) were satisfied with the course. Self-confidence in knowledge about various contents improved significantly: the fundamentals of electrosurgery (post, p < 0.001; 6 months, p = 0.01), mechanism and prevention of adverse events (post, p = 0.001; 6 months, p = 0.04), monopolar instruments (post, p = 0.002; 6 months, p = 0.01), bipolar instruments (post, p = 0.01; 6 months, p = 0.06), and integration with other medical devices (post, p = 0.006; 6 months, p = 0.02). The presentation skill index scores of self- and peer assessments improved after the in-person training (self-assessment [pre 44 vs. post 56, p < 0.001], peer assessment [pre 39 vs. post 68, p < 0.001]). CONCLUSIONS: The hybrid TTT course can provide FUSE-certified personnel with an improved self-confidence concerning knowledge of surgical energy and improve their presentation skills with midterm retention. This can help build trainees' self-confidence as instructors.

DOI PubMed

A Rare Case of Small Intestinal Cancer With Uterine Metastasis After Surgery for Ovarian Metastasis, Diagnosed Using Immunostaining.

Sachiko Nagao, Motoki Matsuura, Shoko Kurokawa, Masato Tamate, Taishi Akimoto, Tsuyoshi Saito

Case reports in oncological medicine 2024 8551816 - 8551816 2024 [International journal]

Uterine metastases from extragenital sites are rare. We present a case of a woman who had undergone surgery for small intestinal cancer and subsequently developed metastases in her left ovary and uterus. A nulliparous woman in her 50s underwent laparoscopic partial small bowel resection with lymph node dissection for small intestinal cancer. Five months later, computed tomography (CT) revealed a left ovarian tumor and ascites. She underwent bilateral adnexectomy and adjuvant chemotherapy, and the ovarian tumor was diagnosed as a small intestinal cancer metastasis. Two years after the small intestinal cancer surgery, a positron emission tomography (PET)-CT scan revealed a uterine accumulation. Cervical cytology was negative for intraepithelial lesion or malignancy. Endometrial histology showed an adenocarcinoma of the uterus. The patient underwent total abdominal hysterectomy followed by adjuvant chemotherapy. Histopathology and immunohistochemistry of the uterine tumor revealed that it was a metastasis of small intestinal cancer (Cytokeratin 7 [CK7] [-], Cytokeratin 20 [CK20] [+], Special AT-Rich Sequence-Binding Protein 2 [SATB2] [+], Paired Box Gene 2 [PAX2] [-], and estrogen receptor [ER] [-]). In patients with cancer, histopathology and immunohistochemistry are important for distinguishing between primary and metastatic tumors and for guiding the choice of treatment.

DOI PubMed

Diagnosis and Methods of Repair for a Uteroperitoneal Fistula (UPF) Formed After Gynecological Surgeries.

Nagisa Wada, Masato Tamate, Motoki Matsuura, Tsuyoshi Saito

Cureus 15 ( 12 ) e51064 2023.12 [International journal]

A uteroperitoneal fistula (UPF) is a rare disorder that can lead to infertility and has never been reported. UPFs can cause infertility and perinatal complications. A 34-year-old woman (gravida 0) with a history of three gynecological surgeries using a uterine manipulator was diagnosed with a UPF using hysteroscopy and hysterosalpingography. She underwent laparoscopic uterine repair as an infertility treatment. The uterine perforation may have been caused by uterine manipulator insertion or suture failure in the myometrium during her previous laparoscopic myomectomy and cystectomy procedures. The UPF disappeared after the current surgical treatment. The complications of UPFs include infection, infertility, ectopic pregnancy, and uterine rupture. We expected that the presence of a fistula would increase the risk of impaired fertilization, implantation failure, and ectopic pregnancy. This case report contributes valuable insights into the diagnosis of UPFs and their laparoscopic repair.

DOI PubMed

婦人科内視鏡技術認定医が不在である当院でのTLHの取り組み

西森貢隆, 嶋田浩志, 藤部佑哉, 鈴木美紀, 玉手雅人, 松浦基樹, 岩崎雅宏, 齋藤豪

北海道産科婦人科学会会誌 ( 北海道産科婦人科学会 ) 67 ( 1 ) 91 - 91 2023.12

Identification of cancer driver mutations in liquid-based cytology samples for the screening of endometrial diseases

Motoki Matsuura, Kiyoko Takane, Kiyoshi Yamaguchi, Tsuneo Ikenoue, Seira Hatakeyama, Shoko Kurokawa, Masato Tamate, Taishi Akimoto, Masahiro Iwasaki, Shintaro Sugita, Tadashi Hasegawa, Yasunori Ota, Tsuyoshi Saito, Yoichi Furukawa

BJC Reports ( Springer Science and Business Media LLC ) 1 ( 1 ) 18 - 18 2023.11 [International journal]

Abstract Background Endometrial cancer (EC) is one of the leading causes of cancer death among women and early detection is crucial for its successful treatment. We previously showed that cytological examination combined with genetic analysis using liquid-based cytology (LBC) samples improved the diagnostic sensitivity of EC. Methods Among 218 individuals who underwent endometrial screening by LBC, 208 samples were analysed by cancer-panel sequencing. Excluding 13 samples with low sequence coverage, we further analysed 195 samples. Results Among the 195 women analysed, 39 and 15 were eventually shown to suffer from malignant endometrial and non-endometrial neoplasms, respectively. Driver mutation(s) were found in nine of the 15 cytology-negative patients with endometrial malignancy, corroborating that combination of cytological and genetic analyses should increase the sensitivity of the diagnosis of malignant endometrial neoplasms. Importantly, driver alterations were found in 32 of 125 women without malignant or premalignant diseases, which raises caution for the interpretation of genetic alterations detected in the endometrial samples. Comparison between the driver mutations in the 32 subjects and those in the 29 endometrial malignancies unveiled that the number of mutations and mutations in PTEN, CTNNB1, and TP53 may be applied for the assessment and prediction of development of EC. Conclusions The genetic analysis combined with liquid-based cytology is useful to improve the diagnostic sensitivity of endometrial neoplasms. However, caution must be taken when cancer-associated mutation(s) are detected in the genetic analysis. Further investigation may clarify the risk of malignant endometrial neoplasms in women with driver mutation(s).

DOI PubMed

【婦人科悪性腫瘍手術-トラブルシューティングとその予防法-】単純外陰切除術

齋藤豪, 松浦基樹, 玉手雅人, 真里谷奨

産婦人科の実際 ( 金原出版(株) ) 72 ( 12 ) 1397 - 1401 2023.11

Clinical characteristics and prognostic factors of endometrial stromal sarcoma and undifferentiated uterine sarcoma confirmed by central pathologic review: A multi-institutional retrospective study from the Japanese Clinical Oncology Group.

Akira Kikuchi, Hiroshi Yoshida, Hitoshi Tsuda, Shin Nishio, Shiro Suzuki, Kazuhiro Takehara, Nao Kino, Toshiyuki Sumi, Kazuyoshi Kato, Masatoshi Yokoyama, Kazuto Nakamura, Masashi Takano, Shinya Sato, Hisamori Kato, Masato Tamate, Koji Horie, Tomoyasu Kato, Atsuhiko Sakamoto, Masaharu Fukunaga, Tsunehisa Kaku, Masayuki Yoshida, Nobuo Yaegashi, Toyomi Satoh

Gynecologic oncology 176 82 - 89 2023.09 [International journal]

OBJECTIVES: Low-grade and high-grade endometrial stromal sarcomas (LGESS and HGESS) and undifferentiated uterine sarcomas (UUS) are rare tumors whose pathological classification and staging system have changed recently. These tumors are reported to contain fusion genes. We aimed to clarify the genetic background, clinical features, prognostic factors, and optimal therapy of these tumors using a new classification and staging system. METHODS: We analyzed the clinical features and prognostic information of 72 patients with LGESS, 25 with HGESS, and 16 with UUS using central pathological review. Estrogen and progesterone receptors (PgRs) were examined by immunohistochemistry. JAZF1-SUZ12 and YWHAE-NUTM2A/B gene fusions were tested using real-time polymerase chain reaction. RESULTS: The 5-year overall survival (OS) rates of LGESS, HGESS, and UUS were 94%, 53%, and 25%, respectively. In LGESS, stage IV, incomplete surgery, and absence of PgR were associated with poor OS. The presence of JAZF1-SUZ12 fusion gene was not associated with OS. In HGESS, the relationship between stage and prognosis was unclear. None of the 3 patients with YWHAE-NUTM2A/B fusion gene died during follow-up. Adjuvant chemotherapy was associated with a favorable OS. Incomplete resection of UUS was associated with poor OS; however, residual tumors frequently occurred. Although most patients underwent adjuvant chemotherapy, their prognosis was extremely poor even in stage I disease. CONCLUSIONS: Prognosis of LGESS is generally good; however, stage IV, incomplete surgery, and PgR-negative tumors are associated with poor prognosis. Adjuvant chemotherapy may be useful for HGESS. Prognosis of UUS is extremely poor, even with adjuvant chemotherapy.

DOI PubMed

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Papers - TAMATE MASATO