術後10年目に手術器具破損が判明し腹腔鏡下に異物除去術を施行した1症例

抄録

Introduction: Breakage of instruments during laparoscopic surgery is rare, but may carry serious medicolegal implications. We report a patient in whom a small piece of broken instrument was found 10 years after surgery, and was laparoscopically removed with the guidance of intraoperative X-ray fluoroscopy.

Case presentation: A 45-year-old gravida 0, para 0 woman had undergone laparoscopic myomectomy 10 years ago in our hospital. Submucous myoma was detected by ultrasonography at another hospital. She underwent magnetic resonance imaging (MRI) for planning further treatment. MRI was canceled because of an artifact. She was referred to our hospital after an unidentified metal object was detected by pelvic MRI. The patient had no history of other surgeries. After abdominal X-ray examination and computed tomography, we assumed that the object, approximately 3 mm in diameter, was a remnant of her previous surgery. Informed consent was obtained. Because she preferred laparoscopic removal, we carefully removed the object, which was located under the right uterosacral ligament, along with surrounding connective tissue under X-ray fluoroscopy.

Conclusion: With increasing numbers of laparoscopic surgeries, remnant iatrogenic foreign bodies, as in the present case, may be found more frequently in the future. It is important for surgeons to prepare for such situations with appropriate informed consent to remove unexpected breakage of instruments. When small foreign bodies buried in the tissue are removed, it may be better to remove these remnants en bloc with the surrounding tissue under fluoroscopic guidance.