抄録
Several difficulties can be experienced during surgery of obese women with endometrial cancer, such as unclear surgical field view, bowel dysfunction, and wound dehiscence or infection after surgery, particularly, in laparotomy cases. However, many researchers report that obese women with early stage endometrial cancer can be safely managed through laparoscopy, with an excellent surgical outcome, shorter hospitalization, and less postoperative pain than those managed through laparotomy. We report the case of a highly obese woman with endometrial cancer who underwent laparoscopic modified radical hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymph node dissection. The patient was 43 years old, gravida 2, para 0, weighing 109 kg, with BMI of 44.8 kg/m2, and diagnosed preoperatively with endometrial cancer stage IB (FIGO staging) and endometrioid adenocarcinoma of grade 2. The patient was placed on a MagicBed® (vacuum posture fixing device) and the abdominal wall was lifted with fixation-tapes. Vital signs were recorded in various postures under general anesthesia, before all surgical procedures. Endclose® was used for lifting up the uterus and for wound closure. Surgery was performed uneventfully under a clear operative view. The patient was discharged on the 6th day. On the 17th day, paclitaxel-carboplatin chemotherapy was initiated, as the histopathology results had revealed pelvic lymph node metastasis. The preparation and invention to the surgery resulted in satisfactory outcome without any complications, although the patient was obese. Considering the ergonomic aspects related to surgeons, further inventions are necessary for long and complicated surgeries such as the para-aortic lymph nodes dissection in case of malignant tumor.
