Background: Recent studies have demonstrated that the tumor microenvironment, known to be influenced by inflammatory cells, plays a crucial role in cancer progression and clinical outcome of patients. The objective of the present study was to investigate prognostic values of preoperative neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) for disease-free survival (DFS) and overall survival (OS) of uterine sarcoma patients. Methods: Ninety-nine patients with uterine sarcoma treated in eight multicenter institutions over the last 20 years were retrospectively analyzed. Curves of DFS and OS were calculated using the Kaplan–Meier method, and univariate and multivariate analyses of various prognostic factors were performed using a Cox proportional hazard regression model. Results: High NLR was significantly associated with worse DFS (p = 0.007) and OS (p = 0.039). Advanced stage (p = 0.017) and high mitotic index (p = 0.036) retained their prognostic significance for DFS. Other clinical variables, including PLR, CA125, and lactate dehydrogenase (LDH) failed to show significant impact. Conclusions: Our findings showed that an elevated preoperative NLR was associated with poor clinical outcome in uterine sarcoma patients. Our results suggest that high NLR in early-stage uterine sarcoma patients might indicate that such patients need more intensive treatments.

Background: Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) was introduced in 2012, but the technique is not yet widely used for ovarian cystectomy. We aim to introduce a new gasless ovarian hemostatic suturing technique for ovarian cystectomy using vNOTES. Methods: We conducted a prospective study using a novel technique for vNOTES ovarian cystectomy. Our vNOTES port (a wound retractor and a disposable glove) was inserted transvaginally through a posterior colpotomy. After ovarian cystectomy, removal of the glove created a gasless state. Hemostatic suturing of the ovary was performed through a vaginal speculum inserted through the wound retractor, under direct observation. Results: Twenty ovarian cystectomies were performed through vNOTES at our institution between June 2019 and February 2020. The mean patient age was 34.2 years (range, 24–51 years). Four patients (20%) underwent bilateral cystectomy and 16 patients (80%) underwent unilateral cystectomy. The mean operative time was 58.7 minutes (bilateral, 57.5 minutes; unilateral, 58.9 minutes), and the mean ovarian hemostatic suturing time was 4.3 minutes (bilateral, 5 minutes; unilateral, 4.1 minutes). Ten patients (50%) received additional medication for pain control within 30 minutes of surgery. All patients were discharged within 24 hours, and 11 were discharged within 12 hours. Conclusion: The gasless hemostatic suturing technique for vNOTES, using a speculum to observe the suturing process, is easy to perform and allows for rapid ovarian hemostasis.

Background/Objectives: This study aimed to compare the surgical and reproductive outcomes between open and robot-assisted laparoscopic adenomyomectomy in women with symptomatic adenomyosis. Methods: This was a prospective cohort study conducted between 29 April 2017 and 21 December 2023 at a university-affiliated tertiary hospital in Seoul, Republic of Korea. The study included patients who underwent uterus-sparing adenomyomectomy for symptomatic adenomyosis. Eligible participants were premenopausal women seeking fertility preservation or symptomatic relief when medical therapy was ineffective and hysterectomy was not desired. Interventions consisted of open adenomyomectomy and robot-assisted laparoscopic adenomyomectomy. Results: A total of 76 patients were included: 21 underwent open adenomyomectomy (OA) and 55 received robot-assisted laparoscopic surgery (RLA). Patients in the OA group had larger adenomyotic lesions (7.1 ± 2.7 vs. 5.4 ± 1.7 cm, p = 0.001) and greater estimated blood loss (400 mL [200–700] vs. 300 mL [200–400], p = 0.05). Hospitalization was significantly shorter in the RLA group (β = −2.1 days, 95% CI −2.7 to −1.6, p < 0.001) after adjustment for lesion size. Overall delivery rates were comparable; however, the robotic cohort demonstrated fewer intraoperative endometrial exposures (10.0% vs. 55.6%, p = 0.033) and more favorable obstetric outcomes, with most deliveries reaching full term without postpartum complications. Conclusions: Compared with open surgery, robot-assisted laparoscopic adenomyomectomy was associated with reduced blood loss, shorter recovery, and favorable reproductive outcomes, supporting its value as a uterus-sparing treatment.

Objective: The objective of this randomized controlled trial was to compare the effect of bowel preparation using only oral polyethylene glycol electrolyte (PEG) solution versus oral PEG solution combined with mechanical sodium phosphate (NaP) enema on the surgical field visualization in patients undergoing robot-assisted laparoscopic gynecologic procedures. Methods: Participants were randomized to either a single oral PEG solution or an oral PEG solution combined by mechanical NaP enema. The intraoperative visualization of the surgical field, the ease of manipulation of the bowels, and overall difficulty level of the surgery were evaluated by the surgeon using a self-administered questionnaire. After the surgery, the patients completed a survey assessing postoperative gastrointestinal discomfort. Results: A total of 114 women were enrolled and randomized to oral PEG solution-only group (n = 48), and oral PEG plus mechanical NaP enema group (n = 66). Forty-two women in oral PEG-only group and 59 oral PEG plus NaP enema group completed the study. There was no difference in intraoperative visualization or overall difficulty of the operation between the two groups, and bowel manipulation was easier in the oral PEG-only group. Also, there was no difference in operating time between the groups. The patients’ level of gastrointestinal discomfort after the surgery was not significantly different between the two groups. Conclusion: Routine use of mechanical NaP enema before robot-assisted laparoscopic gynecologic surgery is not recommended, because it has no additional benefit regarding intraoperative visualization or the surgical level of difficulty over oral bowel preparation methods.

Objective: The prevalence of steatotic liver disease (SLD) is increasing globally. Endometriosis, affecting up to 10% of women, is a major cause of infertility. While associations between endometriosis and metabolic syndrome have been reported, its relationship with SLD remains unclear. Our study aimed to evaluate the association between endometriosis severity and SLD. Methods: We retrospectively analyzed women who underwent surgery for endometriosis with documented revised American Society for Reproductive Medicine scores at a tertiary hospital (January 1, 2009, to February 28, 2025) and had undergone abdominal computed tomography (CT) within 6 months as part of the clinical evaluation for endometriosis. Hepatic steatosis was assessed on abdominal CT using the liver‐to‐spleen Hounsfield unit (LS) ratio with predefined cutoff values, where lower values indicate greater hepatic fat accumulation, and SLD and severe SLD were defined as LS <1.0 and <0.8, respectively. The hepatic steatosis index (HSI) was used for sensitivity analysis. Results: Among 455 patients, 232 had severe endometriosis (SE, stage 4) and 223 had non‐severe endometriosis (NSE). Baseline characteristics were similar between groups, except for higher estradiol levels in the SE group ( P < 0.001). The prevalence of SLD was significantly lower in SE (48.3%) compared to NSE (62.3%) ( P = 0.002), and severe SLD was less common in SE (8.2% vs 16.1%, P = 0.009). Patients with SLD exhibited lower estradiol levels than those without, suggesting a potential protective effect of estradiol on hepatic steatosis. Multivariate analysis confirmed that SE was independently associated with a reduced risk of SLD, irrespective of age, body mass index, and metabolic comorbidities. Conclusions: SE was associated with a lower prevalence of SLD, potentially mediated by higher estradiol levels.