悪性腫瘍専門施設における婦人科腹腔鏡下腟式子宮全摘術導入の試み

抄録

Purpose: Laparoscopic surgery for endometrial cancer became covered by health insurance in Japan. As laparoscopic surgery for cervical cancer has been included in "advanced medical care", demand for such procedures for patients with early stage gynecological cancer is increasing. At our hospital, which is a public regional cancer center, total laparoscopic hysterectomy (TLH) has been newly introduced. We report on the first five cases treated with this procedure at our hospital.

Methods: An application was made to the ethical review board at our hospital for the new procedure. The first five cases required the cooperation of a certified doctor in other relevant hospitals. The patients included one case of atypical endometrial hyperplasia, two cases of stage Ia1 cervical cancer (following cervical conization), one case of intraepithelial adenocarcinoma of the cervix (following cervical conization), and one case of persistent high-grade squamous intraepithelial lesion (HSIL) that was initially treated with cervical conization. In each case, TLH and resection of adnexa and/or fallopian tubes was performed. The procedure was divided into six steps, and the time required for each step was measured.

Results: No serious complications occurred postoperatively. None of the patients required any further treatment, even though stage Ia1 infiltrating cervical cancer was found in the resected uterus of the patient with persistent abnormal cytodiagnosis. The time required for identification and severing of the uterine artery tended to decrease with each case. However, the time required for vaginal and peritoneal suturing did not improve.

Conclusions: TLH was successfully introduced in our hospital. Our results suggest that one appropriate indication for this procedure would be for cases of early stage cervical cancer following conization, as in this case, a positive oncologic outcome can be expected with a low risk of serious complications. Safe introduction of laparoscopic procedures requires coordination with other facilities and careful case selection at malignant tumor specializing hospitals that are not yet familiar with laparoscopic surgery. Gynecologic oncologists who are experienced in open surgery require practice using dry box training to learn suturing and ligature techniques to make the transition from open to laparoscopic procedures.