Ayano Shimizu's research while affiliated with International University of Health and Welfare and other places

Background: Giant malignant tumors have an increased risk of intraoperative rupture, which might lead to a worse disease condition and tumor recurrence. We performed a clinical study on patients with a giant ovarian mass who underwent laparoscopy combined with an Aron Alpha method. Methods: This retrospective clinical study spanned from January 2016 to September 2022 and included 23 patients with giant ovarian tumors treated with an Aron Alpha method. Results: The mean age of the subjects was 47.6 ± 17.8 years, mean tumor diameter 20.4 ± 5.8 cm, mean surgical duration 87.2 ± 33.1 min, and mean hemorrhage volume 94.1 ± 92.2 mL. No patient experienced intraoperative tumor rupture or surgery-related symptoms. Histopathology of excised samples revealed serous cyst adenoma and mucinous cystadenoma, mucinous cystadenoma of borderline malignancy and mature cystic teratoma, and endometriotic cyst adenoma in 6, 4, and 3 patients, respectively. The mean hospitalization period was 6.0 ± 1.2 days, and the hospitalization period was not extended in any subject. Conclusion: The Aron Alpha method allows tumor resection without capsular rupture and is a useful, minimally invasive surgical method for resecting giant ovarian tumors in which malignancy cannot be ruled out.

Purpose: We assessed the effectiveness of preoperative evaluation using comprehensive geriatric assessment (CGA) and estimation of physiologic ability and surgical stress (E-PASS), the Aron Alpha method, and perioperative management based on Enhanced Recovery After Surgery (ERAS) for giant ovarian tumors in elderly adults. Methods: We focused on five giant ovarian tumor cases among elderly patients. Preoperative evaluation using the E-PASS scoring system and CGA was performed. Furthermore, the minimally invasive surgical method, the Aron Alpha method, was conducted, and we performed perioperative management using ERAS. Results: The mean age was 75.8±8.8 years, and the comorbidities were hypertension in three cases, hyperlipidemia in two cases, angina pectoris in one case, cholecystitis in one case, and lower extremity varicose veins in one case. The mean tumor size was 21.0±5.4 cm. The examination using the E-PASS scoring system showed a preoperative risk score of 0.7±0.4, surgical stress score of 0, and comprehensive risk score of 0.3±0.3. In CGA, two cases had problems with instrumental activities of daily living and cognitive function. The mean duration of surgery was 89.0±16.6 minutes, and the mean blood loss was 56.0±65.4 mL. No surgery-associated complications were observed, and early postoperative ambulation, rehabilitation intervention, and postoperative analgesic management were conducted. No patients had prolonged hospitalization and activities of daily living decline. Conclusion: We were able to confirm the usefulness and safety of the minimally invasive Aron Alpha method and ERAS-based perioperative management of giant ovarian tumors in elderly patients by performing a detailed preoperative evaluation using CGA and E-PASS.

Background: Hypermenorrhea is characterized by excessive menstrual bleeding that causes severe anemia and interferes with everyday life. This condition can restrict women's social activities and decrease their quality of life. Microwave endometrial ablation (MEA) using a 2.45-GHz energy source is a minimally invasive alternative to conventional hysterectomy for treating hypermenorrhea that is resistant to conservative treatment, triggered by systemic disease or medications, or caused by uterine myomas and fibrosis. The popularity of MEA has increased worldwide. Although MEA can safely and effectively treat submucous myomas, some patients may still experience recurrent hypermenorrhea postoperatively and may require additional treatment. Aim: To investigate the efficacy of MEA combined with transcervical resection (TCR). Methods: Participants underwent cervical and endometrial evaluations. Magnetic resonance imaging and hysteroscopy were performed to evaluate the size and location of the myomas. TCR was performed before MEA using a hystero-resectoscope. MEA was performed using transabdominal ultrasound. The variables included operation time, number of ablation cycles, length of hospital stay, and visual analog scale cores for hypermenorrhea, dysmenorrhea, and treatment satisfaction at 3 and 6 mo postoperatively. The postoperative incidence of amenorrhea, changes in hemoglobin concentrations, and MEA-related complications were evaluated. Results: A total of 34 women underwent a combination of MEA and TCR during the study period. Two patients were excluded from the study as their histopathological tests identified uterine malignancies (uterine sarcoma and endometrial cancer). The 32 eligible women (6 nulliparous, 26 multiparous) had a mean age of 45.2 ± 4.3 years (range: 36-52 years). Patients reported very severe hypermenorrhea (10/10 points on the visual analog scale) before the procedure. However, after the procedure, the hypermenorrhea scores decreased to 1.2 ± 1.3 and 0.9 ± 1.3 at 3 and 6 mo, respectively (P < 0.001). The mean follow-up duration was 33.8 ± 16.8 mo. Although 10 women (31.3%) developed amenorrhea during this period, none experienced a recurrence of hypermenorrhea. No surgical complications were observed. Conclusion: Reducing the size of uterine myomas by combining MEA and TCR can safely and effectively treat hypermenorrhea in patients with submucous myomas.

Microwave endometrial ablation (MEA) is a minimally invasive treatment for uterine myoma with hypermenorrhea, which can replace conventional hysterectomy. However, cases requiring additional treatment because of postoperative recurrence are often encountered. MEA cauterizes the endometrium and is not recommended for patients who wish to preserve fertility. We present the cases of a patient with myoma-related hypermenorrhea who underwent microwave ablation of the inflowing blood vessels to the uterine myoma under transvaginal ultrasound guidance. A 43-year-old woman was diagnosed with chronic myeloid leukemia and treated with dasatinib 2 years ago. Worsening hypermenorrhea was observed after treatment initiation. Ultrasound and pelvic magnetic resonance imaging revealed a uterine myoma. Therefore, she underwent MEA under transvaginal ultrasound guidance. Visual analog scale evaluation demonstrated considerable improvement in hypermenorrhea and dysmenorrhea; the myoma size showed reduction. The postoperative course was uneventful, and the patient was discharged on the day after surgery. No postoperative complications were observed. This patient is currently undergoing infertility treatment. The microwave ablation of myoma under transvaginal ultrasound guidance can effectively and safely reduce the myoma size. These findings suggest that this method is a novel treatment option for patients with myoma-related hypermenorrhea who wish to preserve their fertility and have children.

Background Submucous uterine myomas can be effectively and safely treated using microwave endometrial ablation (MEA). However, recurrence is common and requires additional treatment. This study investigated the efficacy of MEA combined with transcervical resection (TCR). Methods This retrospective study included 32 women who underwent MEA in addition to TCR for submucous uterine myomas at the International University of Medicine and Welfare Hospital between January 2016 and June 2020. All patients were followed up for ≥ 6 months after the procedure. Results The 32 women had a mean age of 45.2 ± 4.3 years. The myomas had a mean major diameter of 26.3 ± 12.3 mm and a protrusion degree of 51.3 ± 11.3%. The patients reported very severe hypermenorrhea/dysmenorrhea (10/10 points on the visual analogue scale) before the procedure. After the procedure, the hypermenorrhea scores decreased to 1.2 ± 1.3 and 0.9 ± 1.3 after 3 and 6 months, respectively (both p < 0.001). The dysmenorrhea scores also decreased to 1.3 ± 1.8 and 1.3 ± 1.8 after 3 and 6 months, respectively (both p < 0.001). Circulating hemoglobin concentrations improved significantly from 8.7 ± 1.9 g/dL to 13.5 ± 1.1 g/dL (p < 0.001). The mean follow-up duration was 33.8 ± 16.8 months and 10 women (31.3%) developed amenorrhea during this period, although none experienced recurrence of hypermenorrhea. No surgical complications were observed. The patients reported being highly satisfied with the ability of the combined treatment to relieve hypermenorrhea (mean visual analogue scale score: 9.5 ± 0.8). Conclusion Reducing the size of uterine fibroids via a combination of MEA and TCR can safely and effectively treat hypermenorrhea in patients with submucous myomas. Furthermore, the procedure’s effectiveness is complemented by the patients’ high satisfaction level.