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Abstract Embryo implantation is crucial for successful pregnancy, requiring appropriate uterine responses to implantation-competent blastocysts. Molecular communication at the maternal–fetal junction governs this process. Leukemia inhibitory factor (Lif) plays a pivotal role in implantation across species. Lif is abundantly expressed in the glandular epithelium during blastocyst-receptive phase and is induced in the stroma surrounding attached blastocysts. While diminished Lif expression leads to infertility, its influence on peri-implantation uteri remains unclear. Therefore, we investigated the role of Lif in uterine physiology using its uterine-specific knockout (uKO) and uterine epithelial-specific KO (eKO) in mice. Lif eKO and uKO mice displayed infertility owing to failed embryo attachment. Recombinant Lif supplementation rescued the reproductive phenotype of Lif eKO mice, but not Lif uKO mice; however, recombinant Lif injection rescued embryo attachment in Lif uKO mice. RNA-seq analysis indicated that Lif governs uterine epithelial genes, but not embryonic genes, to facilitate embryo attachment via activating nuclear Stat3. Concordantly, three-dimensional imaging of the uterine epithelium revealed that luminal closure and crypt formation are regulated by the uterine Lif–Stat3 axis as well as the presence of blastocysts. Collectively, our findings shed light on previously unknown mechanism on how Lif influences uterine functions molecularly and physiologically during early pregnancy.

Objectives: The objective of the study was to evaluate the feasibility and quality of anesthesia-free in-office hysteroscopic morcellation for the treatment of endometrial polyps. Materials and Methods: A prospective, single-center, open-label, single-arm clinical trial was conducted to evaluate the efficacy of hysteroscopic morcellation for endometrial polyps or retained products of conception. All surgical procedures were performed using the TruClear™ 5C system in the office setting without anesthesia. The primary endpoint was the success rate of surgery, defined as the completion of the operation. The secondary endpoints were operating time, fluid deficit, adverse events, pain evaluated by Visual Analog Scale (VAS) scores, and recurrence rate. Results: Ninety-five patients underwent hysteroscopic morcellation without anesthesia and received the treatment. The success rate of surgery was 100% (95/95), and the mean operating time was 7.3 min. Adverse events occurred in only 2.1% (2/95), with vasovagal reflex. The mean VAS scores during the procedure ranged from 2.4 to 3.1, and the recurrence rate after 6 months was 2.1% (1/47), with a pregnancy rate of 33% (11/33). When comparing nulliparous and parous patients, the success rate and the operating time were equivalent, and the mean VAS scores during the procedure were both within tolerable levels but significantly higher in nulliparous patients (3.3–4.5 vs. 1.6–1.9, P < 0.001). Conclusion: This study demonstrated that anesthesia-free in-office hysteroscopic morcellation for endometrial polyps can be safely performed with feasible quality and only tolerable pain. This less-invasive procedure is expected to become more widespread in future.

Abstract Background Adenomyosis is a common gynecological disease in women of reproductive age and causes various symptoms such as dysmenorrhea and heavy menstrual bleeding. However, the influence of pregnancy on the progression of adenomyosis remains unclear. The insight into whether the size of adenomyosis is increased, decreased, or unchanged during pregnancy is also undetermined. The current study aimed to evaluate the influence of pregnancy in patients with symptomatic adenomyosis. Methods This study retrospectively enrolled patients diagnosed with adenomyosis by magnetic resonance imaging between 2015 and 2022 at The University of Tokyo Hospital. Uterine size changes were evaluated by two imaging examinations. In the pregnancy group, the patients did not receive any hormonal and surgical treatments, except cesarean section, but experienced pregnancy and delivery between the first and second imaging examinations. In the control group (nonpregnancy group), the patients experienced neither hormonal and surgical treatments nor pregnancy from at least 1 year before the first imaging to the second imaging. The enlargement rate of the uterine size per year (percentage) was calculated by the uterine volume changes (cm3) divided by the interval (years) between two imaging examinations. The enlargement rate of the uterine size per year was compared between the pregnancy group and the control group. Results Thirteen and 11 patients with symptomatic adenomyosis were included in the pregnancy group and in the control group, respectively. The pregnancy group had a lower enlargement rate per year than the control group (mean ± SE: −7.4% ± 3.6% vs. 48.0% ± 18.5%, P

Objective: With the increased use of total laparoscopic hysterectomy (TLH), the use of robotic-assisted laparoscopic hysterectomy (RALH) has increased due to its technical advantages. On the other hand, RALH has some disadvantages, including its high cost, which includes not only the purchase price of robotic technology systems but also the running cost and long preparation time for setting assistant robots. Therefore, an overall understanding of the characteristics of RALH is needed. Study design: We reviewed the medical records of 432 patients with TLH and 93 patients with RALH from January 1, 2015, to December 31, 2022. In this analysis, we excluded certain cases with concomitant laparoscopic cystectomy (LC) and a heavy uterus (> 400 g). First, the patient characteristics of the TLH and RALH groups, including operation time and blood loss amount, were compared. Then, among these cases, we sought to predict difficult cases for TLH and RALH by identifying risk factors related to each of the following three categories of operational complications: “long operation time”, “massive blood loss” and “other complications”. For this purpose, multivariate logistic regression analyses were performed to assess the influence of each of 7 representative factors, namely, “advanced age”, “high body mass index (BMI)”, “nulliparity”, “concomitant pelvic lymphadenectomy (PLA)”, “heavy uterus”, “abdominal adhesion”, and “large leiomyoma”. Results: In the simple comparison without various factors, there was an advantage of RALH in both the average operation time and blood loss amount. However, in the multivariate logistic regression analyses, a significant risk was detected in the following relationships: 1) between “long-term operation” and “abdominal adhesion” and 2) between “other complications” and “heavy uterus”. Conclusions: RALH has sufficient advantages over TLH regarding at least in terms of blood loss amount; however, since RALH may have potential weaknesses in the context of complex cases, additional cases and analyses are needed.

Objective: To reduce intraoperative blood loss in laparoscopic myomectomy, uterine artery occlusion or temporary uterine artery clipping have been employed. Recently, in addition to these techniques, temporary uterine artery ligation has been reported as a new method that has less invasive effects on fertility and needs no special devices to be used. This study aimed to evaluate the effect of temporary uterine artery ligation to minimize intraoperative blood loss during laparoscopic myomectomy. Study Design: This was a retrospective case-control study at the department of Obstetrics and Gynaecology, University Hospital Mizonokuchi, Teikyo University School of Medicine. A total of 264 patients with uterine leiomyoma who underwent laparoscopic myomectomy were enrolled in this study. We divided the patients into two groups, those who underwent temporary uterine artery ligation (52 patients) and those who did not (212 patients) and compared the operation time, blood loss volume, and other indexes. Second, to identify influential factors, we assessed the effects of 11 representative factors on massive blood loss or a prolonged operation time using multivariate analysis. Results: The intraoperative blood loss volume was decreased by approximately half with the addition of temporary uterine artery ligation (75.1 ± 73.6 ml vs. 158.5 ± 233.2 ml, p = 0.011), but the operation time was longer (200.5 ± 46.9 min vs. 160.1 ± 51.3 min, p

Background: Minimally invasive surgeries, such as laparoscopic and robotic surgeries, have been the main treatment methods for stage I endometrial cancer instead of laparotomy. However, minimally invasive surgeries for malignant tumors have not yet been established in many rural hospitals or hospitals with few gynecologists. This study aimed to investigate whether laparoscopic or robotic surgery for stage I endometrial cancer is more sustainable and useful at a rural hospital where a single non-laparoscopic-specialized surgeon performs oncologic surgery and provides outpatient care. Methods: This retrospective case-control study was conducted at our hospital. The study enrolled 65 patients with endometrial cancer who underwent robotic-assisted laparoscopic hysterectomy (RALH) or total laparoscopic hysterectomy (TLH). We compared surgical outcomes such as patient background, operation time, blood loss, and other indices. Results: Exactly 34 patients underwent robotic surgery, and 31 underwent laparoscopic surgery. No severe adverse events required reoperation, conversion to laparotomy, or ureteral injury during either operation. The operation time decreased in patients who underwent robotic surgery compared with those who underwent laparoscopic surgery (193 (140–227) vs. 253 (219–287) min, p < 0.001). In addition, the blood loss volume decreased by half in patients who underwent robotic surgery compared to those who underwent laparoscopic surgery. Significantly more operations were completed by two operators rather than three operators at robotic surgery compared to laparoscopic surgery (59% vs. 26%, p = 0.007). The hospitalization days were 1.5 days shorter in the robotic surgery group than in the laparoscopic surgery group (p < 0.001). Exactly 18 patients underwent robotic surgery with pelvic lymphadenectomy, and 26 underwent laparoscopic surgery with pelvic lymphadenectomy. Patients who underwent robotic surgery required less operation time than those who underwent laparoscopic surgery (226 (199–246) vs. 261 (236–287) min, p = 0.001). Conclusions: In the surgical treatment of stage I endometrial cancer, robotic surgery was associated with a significantly shorter operation time, shorter hospital stay, and no obvious complications. This study proposes that robotic surgery is a promising solution for the sustainable introduction of minimally invasive surgery for stage I endometrial cancer in rural hospitals or hospitals with few gynecologists.

Uterine inversion is a rare puerperal event in the third stage of labor. Nonpuerperal uterine inversion is even rarer and is mainly caused by uterine fibroids, uterine sarcoma, or endometrial cancer. This is the first report of uterine inversion caused by cervical cancer. A 67-year-old woman presented with a 10 cm pelvic mass. Contrast-enhanced magnetic resonance imaging revealed uterine inversion, which was preoperatively diagnosed to be caused by endometrial cancer and was treated using an extended abdominal hysterectomy. Postoperative histopathological examination revealed that the primary tumor was a squamous cell carcinoma with coexistent high-grade squamous intraepithelial lesions and small-cell neuroendocrine carcinoma. Immunostaining was diffusely positive for p16 and negative for estrogen receptors. The postoperative diagnosis was cervical squamous cell carcinoma. Our observations suggested that cervical carcinoma can cause uterine inversion by invading the corpus.