For about 8, 000inhabitants of Nagato-machi and Wada-mura, Nagano prefecture, various mass screenings have been carried out for this 14years. These are gastric mass survey carried out from 1971, primary health screening from 1972, multiphasic health testing and service from 1978, mass screening for breast and thyroid cancer from 1980 and ultrasonographic mass screening for liver, gallbladder and pancreas cancer from 1983.
Among the total of 38, 593examinees, 90patients 92diseases were detected to be operated. Maligant diseases are 9kinds 40patients 42diseases and benign ones are llkinds 50patients.
The largest number of the diseases is 29gastric cancers. Almost of malignant diseases, 36/ 40patients, were detected sincel978 and their prognosis are very good, namely 2patients of gastric cancer, one hepatoma and one breast cancer have died of the malady and one bile duct cancer died of other disease until now.
The route of detection and prognosis of all operated patients, the present condition and the policy of all mass screenings and the necessity of increase of the examinees, especially the old men and women, are discussed.

Since Sep. 1978, 123 patients of gastric cancer were operated in our hospital, 32 patients of them were detected by gastric mass rurvey (MS group) and 91 were outpatients (OP group).
Clinically and histologically, we have reviewed and compared the two groups about the process of detection, the treatment and the prognosis.
Results are as follows.
(1) There were much more patients in MS group than OP group who had no symptom and no complaining period and who had experienced mass survey more frequently. It resulted that the ratio of early gastric cancer of MS and OP group were 68.8% and 33.0% and those who received curative resection were 96.9% and 61.5% respectively.
(2) The cancer occupying the upper third of the stomach was rarely seen and tumorsize less than 0.5 cm was never seen in MS group, but the both were not rarely in OP group which had been examined mainly by endoscopy.
Of course we know that we must make efforts to find these lesions from mass survey. But endoscopical method is more profitable than indirect fluoroscopy to find fine lesions, so it is suggested that endoscopy mass survey will be more useful.
(3) According to The General Rules For The Gastric Cancer Study In Surgery And Pathology (Japanese Research Society For Gastric Cancer), we compared the prognosis of the two groups concerning 4 matters of the patients who were received absolute curative resection, whose cancer invaded to serosa, who had no evidence of regional lymph node involvement and whose histological stage was I or II.
The result was that MS group was superior to OP group on all matters.
The causes, we supposed, were the facts of OP group that many patients were in bad preoperative condition, so the dissections were not made successfully, and that many died of other malady.
Five year survival rates of MS and OP group were 89.8% and 39.0% respectively.

Ureteral injuries are well-known complications of gynecologic surgery, with a higher prevalence in laparoscopic surgery than in laparotomy [1]. The use of near-infrared fluorescent imaging navigation is currently being considered a novel method to identify the ureters intraoperatively and prevent ureteral injuries [2]. The Near-Infrared Ray Catheter (NIRC) fluorescent ureteral catheter is a newly developed device, containing a fluorescent resin that can be recognized by near-infrared irradiation. We found few reports on the use of this catheter in laparoscopic surgery for colon and rectal cancer [3, 4], but no reports in gynecologic surgery. We demonstrate the feasibility, safety, and potential usefulness of the real-time intraoperative visualization of the ureters using a novel NIRC fluorescent ureteral catheter in laparoscopic hysterectomy for endometrial cancer. A 30-year-old woman with early grade 1 endometrioid carcinoma was treated with medroxyprogesterone acetate for fertility preservation. After achieving complete response, she got pregnant and underwent cesarean section. The recurrence of atypical endometrial hyperplasia one year post-delivery prompted a total laparoscopic hysterectomy. Before the laparoscopic surgery began, the NIRC fluorescent ureteral catheters were placed in the ureters under the obtainment of informed consent from the patient. During the surgery, the catheters were successfully visualized by near-infrared fluorescence observation, which helped identify the ureters clearly and prevent ureteral injuries. This novel ureteral imaging navigation is expected to be an effective tool in cases of obesity, severe pelvic adhesion, deep infiltrating endometriosis, and malignancy in gynecologic laparoscopic surgery to clearly identify the ureter and to reduce the risk of ureteral injury.

Objective: The pelvic lymphatic drainage system comprises the upper and lower paracervical pathways (LPPs). Lymph node dissection of the LPP, including the cardinal ligament, internal iliac, internal common iliac, and presacral lymph nodes, requires higher surgical skills because of the anatomical limitations of the pelvic cavity and the dissection of vessels while preserving the nerves in the pelvic floor. In this video, we demonstrate rectal mobilization for laparoscopic complete pelvic lymph node dissection of the LPP in patients with uterine cancer. Methods: Rectal mobilization was performed before complete pelvic lymph node dissection of the LPP. The pararectal space was opened widely and the connective tissue between the presacral fascia and prehypogastric nerve fascia was dissected bilaterally, allowing the rectum to be pulled. Results: This procedure created a wide-open space in the pelvic floor, allowing clear visualization of the nerves and lymph nodes of the LPP. Laparoscopic complete lymph node dissection of the LPP was performed in the open space while preserving the hypogastric and pelvic splanchnic nerves and isolating the extensive network of blood vessels in the pelvic cavity. Conclusion Rectal mobilization enabled the safe execution of laparoscopic complete pelvic lymph node dissection of the LPP in patients with uterine cancer.

Objective: Transvaginal removal of large specimens during laparoscopic hysterectomy can be a complex surgical procedure that poses a risk of organ injury and tissue spillage into the abdominal cavity and is associated with extraction of the specimen and manual morcellation. Our objective was to demonstrate a technique for transvaginal removal of large specimens using the Alexis Contained Extraction System (CES) in laparoscopic hysterectomy. Methods: The technique used for transvaginal removal of large specimens using the Alexis CES was presented in this video. Surgery was performed at a tertiary hospital. Results: Following resection of the specimen during laparoscopic hysterectomy, the Alexis CES was inserted into the abdominal cavity through the umbilical trocar wound. The specimen was placed in a bag to prevent tissue spillage. The ring retractor was guided to the vagina and pulled out transvaginally. By repeatedly turning the ring retractor, tension was applied to the specimen bag, and the vaginal wall was unfolded all around to enable a secure surgical field. During manual morcellation of the specimen in the bag, the retractor was pulled and additionally turned to roll and re-tension the specimen bag when the bag was loosened. The specimen was pushed out of the vagina and safely and effectively extracted without concerns about tissue spillage in the abdominal cavity or related organ injuries. Conclusion The technique for transvaginal removal of large specimens using the Alexis CES enables simple, effective, and safe tissue extraction with contained manual morcellation during laparoscopic hysterectomy.