子宮頸部筋腫に対する全腹腔鏡下子宮全摘術の手術戦略

抄録

  Total laparoscopic hysterectomy (TLH) for uterine cervical myoma is quite challenging. As the ureter, bladder, and uterine artery and vein are deviated due to the myoma, the manipulation of the cervical ligament becomes atypical and risk of damage to the other organs increases. We report the strategy of TLH in a case of cervical myoma, in which it was difficult to insert the uterine manipulator.

  A 47-year–old woman (para 3 living 2), was referred to our hospital with a cervical myoma gradually increasing in size. On speculum examination, the uterine cervix was displaced posteriorly. Ultrasonography and Magnetic Resonance Imaging revealed a cervical myoma 9 cm in size. We planned TLH after Gonadotrophin-releasing hormone agonists therapy. We placed ureteral stents prior to surgery. Direct visualization of the abdominal cavity revealed that the cervical myoma was completely located in the anterior broad ligament of the uterus, and only the uterine body could be recognized. To lift the uterus, we used Vagi pipe^® and pulled the circular ligament and the cervical myoma with a Myoma Borer. On peeling off the bladder or making an incision on the vaginal wall we confirmed the vaginal fornix by Vagi pipe^® and sonde inserted through the Vagi pipe^® operation hole.

  Compared to the conventional method using a ribbon retractor, by using a combination of Vagi pipe^® and sonde, it is possible to simultaneously push up the uterus and identify the vaginal fornix. Moreover, it was possible to make an incision on the vaginal fornix without air leakage using Vagi pipe^®. The operation time was 150 minutes, and the bleeding volume was 400 g; the sample weight was 330 g.

  We predicted the technical difficulties in the surgery and implemented appropriate measures, such as the use of Vagi pipe^®, sonde and ureteral stents. We could, thus, safely perform TLH for uterine cervical myoma.