Kita Masato, Yasuhara Yuki, Sumi Genichiro, Yokoe Takuya, Butsuhara Yusuke, Hisamatsu Yoji, Okada Hidetaka
Department of Obstetrics and Gynecology, Kansai Medical University, Osaka, Japan.
Gynecol Oncol Rep. 2023 Jan 18;45:101135. doi: 10.1016/j.gore.2023.101135. eCollection 2023 Feb.
Vaginoscopy has been mainly used diagnostically due to the lack of adequate equipment for performing complicated surgeries (Johary et al., 2015). However, herein, we report therapeutic vaginal endoscopic surgery (pneumovaginoscopy) for secondary malignant vaginal tumors using the vNOTES technique and devices (Kita et al., 2021, Yokoe et al., 2022). To our knowledge, this report and surgical video demonstrate the first case of successful fertility-sparing R0 tumor resection of a rare primary cervical clear cell adenocarcinoma using pneumovaginoscopy. A 12-year-old girl was referred to our outpatient clinic with a chief complaint of a genital tumor and possible clear cell carcinoma on biopsy. There was no history of diethylstilbestrol exposure. MRI and CT images suggested a polypoid cervical tumor without metastatic lesions. Therefore, we performed therapeutic pneumovaginoscopic surgery with diagnostic laparoscopy and hysteroscopy. The cervical tumor was resected completely, and hysteroscopy and laparoscopy revealed no abnormalities. The total surgical time was 123 min, and the blood loss volume was minimal. R0 resection was achieved microscopically. Postoperatively, we performed a partial cervical resection around the first surgical scar to confirm no residual tumor. There were no postoperative complications, and a 2-year follow-up revealed no recurrence. The standard treatment for early-stage cervical cancer (IA2-IB1) remains radical hysterectomy with pelvic lymphadenectomy. However, fertility-sparing minimally invasive surgery has recently been introduced for clear cell adenocarcinoma of the cervix (Su et al., 2020). Our report supports the possibility of this minimally invasive surgery under exceptional conditions. This study was approved by the ethics committee of Kansai Medical University. Written and signed informed consent was obtained from the patient's legal guardian.
由于缺乏用于进行复杂手术的适当设备，阴道镜检查主要用于诊断（乔哈里等人，2015年）。然而，在此我们报告了使用经阴道自然腔道内镜手术（vNOTES）技术和设备对继发性恶性阴道肿瘤进行的治疗性阴道内镜手术（气腹阴道镜检查）（北田等人，2021年，横江等人，2022年）。据我们所知，本报告及手术视频展示了首例使用气腹阴道镜检查成功进行保留生育功能的R0肿瘤切除的罕见原发性宫颈透明细胞腺癌病例。一名12岁女孩因生殖器肿瘤为主诉并经活检可能为透明细胞癌而被转诊至我们的门诊。她没有己烯雌酚暴露史。磁共振成像（MRI）和计算机断层扫描（CT）图像显示为息肉样宫颈肿瘤，无转移灶。因此，我们进行了诊断性腹腔镜检查和宫腔镜检查的治疗性气腹阴道镜手术。宫颈肿瘤被完全切除，宫腔镜检查和腹腔镜检查未发现异常。总手术时间为123分钟，失血量极少。显微镜下实现了R0切除。术后，我们在第一个手术瘢痕周围进行了部分宫颈切除术以确认无残留肿瘤。无术后并发症，2年随访未发现复发。早期宫颈癌（IA2-IB1）的标准治疗方法仍然是根治性子宫切除术加盆腔淋巴结清扫术。然而，最近已引入针对宫颈透明细胞腺癌的保留生育功能的微创手术（苏等人，2020年）。我们的报告支持在特殊情况下进行这种微创手术的可能性。本研究获得了关西医科大学伦理委员会的批准。已从患者的法定监护人处获得书面并签署的知情同意书。
