当院での全腹腔鏡下子宮全摘術における試み

抄録

Objective: We are currently testing a simplified and safe laparoscopic hysterectomy procedure in our clinical practice that is technically similar to laparotomy. The present study aimed to evaluate the feasibility of this modified total laparoscopic hysterectomy (TLH) method, which uses the RUMI II Colpotomiser System and without requiring separation of the ureter and uterine artery for laparoscopic surgeons under training.

Methods: During the procedure, uterine vessels and ureters are not skeletonized, the vaginal vault is identified using a colpotomy cup, and retrograde dissection is performed from the anterior vaginal wall. We used statistical analysis to evaluate operative time, parity, body mass index (BMI), blood loss, and surgery-related complications by Student's t-test.

Results: We have performed 11 TLH procedures applying the above method, excluding cases of severe adhesion, since 2016. Compared with the traditional TLH method, average operating time was significantly shorter using the new method. There was no significant difference between the two groups with regards to parity, BMI, or blood loss. No complications have occurred postoperatively since 2016; whereas, one vesicovaginal fistula occurred in the 18 TLH performed before 2016.

Conclusion: This simplified TLH procedure may be a safe and effective alternative for laparoscopic beginners as it is similar to that of abdominal hysterectomy. Furthermore, the exclusion of complicated tissue peeling reduces operator stress and surgery-related complications.