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Usefulness of Detailed Analysis with Operative Procedure of Total Laparoscopic Hysterectomy (TLH) Done a Single Surgeon, to Master the Surgical Technique of TLH and Gain Higher Proficiency

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Open Journal of Obstetrics and Gynecology 2022年第11期12卷 1183-1190页

作者： Tsutomu Muramoto Shin Takenaka Ryo Koike megumi sano Kyosuke Kamijo Reproductive Center Nagano Municipal Hospital Nagano Japan Department of Obstetrics and Gynecology Showa University Fujigaoka Hospital Yokohama Japan

Objective: To analyze the relationship between the numbers of cases experienced and the operation time for a single surgeon aiming to master the TLH surgical technique. Material and Methods: Retrospective data analysis of women who underwent TLH for benign diseases between April, 2014 and March, 2016 was conducted by a single surgeon in a single hospital (Showa University of Fujigaoka Hospital). We divided the main procedures of the TLH operation into five sections, and measured the time required for each section. These cases were divided into three groups, group 1, 2, and 3. Results: There were 54 cases of TLH over two years for a single surgeon, and 21 cases that included essential operative procedures were divided into three groups of seven cases each. The average duration of the surgery (min.) was 178.3 ± 48.2 in the group 1, 128.3 ± 15.6 in the group 2, and 111.3 ± 15.9 in the group 3. A significant reduction in the required time was observed between group 1, 2, and 3 groups. As the number of cases increased, the operation time became statistically significantly shorter for every section except B and D. The skill growth rate was different at each section. Conclusion: For a single surgeon, as the number of surgical cases increased, we recognized the increased skill with the procedure in every section and the rate of skill growth differed for different sections. The difference of growth rate for each section implied that the number of operative cases required for a surgeon in each section was different.

关键词： Total Laparoscopic Hysterectomy on the Job Training Learning Curve Surgical Technique of TLH

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A Case of Low-Grade Appendiceal Mucinous Neoplasm of Its Difficultly to Distinguish from a Right Ovarian Tumor Due to Postmenopause

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Open Journal of Obstetrics and Gynecology 2022年第11期12卷 1140-1146页

作者： Tsutomu Muramoto Kyosuke Kamijo megumi sano Yuki Ibuki Atushi Mori Yaeko Kobayashi Nagano Municipal Hospital Department of Obstetrics and Gynecology Nagano Japan

We here present a rare case of appendiceal tumor mimicking ovarian tumor in menopause woman. The patient was a 56-year-old woman, G1P1, who presented to our hospital with a right adnexal cyst diagnosed at another hospital. Transvaginal echocardiography showed a cyst in the right adnexal region, and pelvic contrast-enhanced MRI revealed a small cyst in the same region. The left ovary was atrophic and identifiable. It was unclear whether the cyst was contiguous with the gastrointestinal tract. Blood tests showed no elevation of tumor markers. We considered its possibility of a gastrointestinal origin, but since right normal ovary was not found, we thought the tumor was of ovarian origin and decided on a laparoscopic resection of the right adnexa. Intraoperatively, we observed atrophied bilateral normal ovaries, and the pelvic tumor was contiguous to the appendix. Surgeons performed a laparoscopic appendectomy after consultation with us. After resection we searched the abdominal and pelvic cavities, but found no obvious disseminated lesions. The histological diagnosis was low-grade appendiceal mucinous neoplasm (LAMN), a rare benign tumor of the appendix. Appendiceal tumors can be difficult to differentiate from right ovarian tumors due to their close anatomic location in the pelvis. It is possible to determine whether the tumor is of ovarian or appendiceal origin by identifying normal ovaries and the location of the feeding vessels into the tumors. In our case, there were no lesions other than the appendix, but LAMN can metastasize to the ovary, cause pseudomyoxoma peritonei, or be an overlapping tumor with an ovarian tumor. If an appendiceal tumor is diagnosed after surgery for ovarian tumor, the intra-abdominal cavity should be searched for metastasis or dissemination, and a thorough search for ovarian lesions should be performed with the possibility of an overlapping tumor in mind.

关键词： Low-Grade Appendiceal Mucinous Neoplasm Ovarian Tumor Menopause Woman

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Qualitative Comparison between Rats and Humans in Quadrupedal and Bipedal Locomotion

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Journal of Behavioral and Brain Science 2013年第1期3卷 137-149页

作者： Taisei Hosoido Futoshi Mori Keita Kiyoto Takashi Takagi Yukari sano megumi Goto Katsumi Nakajima Naomi Wada Department of Physiology Kinki University School of Medicine Osaka-Sayama Japan Laboratory of Veterinary System Science Yamaguchi University Yamaguchi Japan Osaka Veterinary Referral Center Osaka Japan

Bipedal (Bp) locomotion is one of the most characteristic motor behaviors in human beings. Innate quadrupedal (Qp) four-legged animals also often walk bipedally. The walking posture, however, is significantly different between the two. This suggests that although both have a potential to walk bipedally, however, the human has a body scheme suitable for Bp locomotion, probably its skeletal system. The skeletal system includes the lumbar lordosis, sacral kyphosis, a round pelvis, a large femur neck angle, short feet, and so on. To verify this hypothesis, we compared kinematic and EMG activities between rats and humans during Qp and Bp locomotion on a treadmill belt. The rat is a representative Qp animal, but it is able to acquire Bp walking capability with motor learning. Although the mobile ranges of the hindlimb joint are different during each locomotor pattern between rats and humans, both showed replicable flexion and extension excursion patterns for each joint depending on the locomotor phase. There are many phase-locked EMG bursts between rats and humans during the same walking task and these are observed in the proximal rather than the distal muscles. This suggests that both rats and humans utilize similar neuronal systems for the elaboration of Qp and Bp locomotion. It was interesting that both subjects showed more muscle activities during non-natural locomotor patterns;Qp < Bp for rats and Bp < Qp for humans. This indicates that rat Bp and human Qp walking need more effort and we may be able to find its reason in their skeletal system.

关键词： Human Rat Evolution Posture Locomotion Bipedal Quadrupedal

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