当院における全腹腔鏡下準広汎子宮全摘術の安全性の評価と標準化に向けた今後の課題

抄録

Objective: Since 2014, we changed the surgical procedure for treatment of early stage endometrial cancer from modified radical hysterectomy (mRH) to total laparoscopic modified radical hysterectomy (TLmRH). When provided with training, even gynecologists with little experience in laparoscopic surgery can perform this procedure. In this study, we compared the results of laparoscopic surgery and laparotomy for treatment of endometrial cancer, further analyzed the results of laparoscopic surgery when performed by each surgeon.

Patients: Eighty-seven cases diagnosed with endometrial cancer stage IA before surgery were examined. Fifty-two TLmRH cases (group A), and 35 mRH cases (group B) were compared. Group A was classified into three groups (C: 16 cases, D: 18, E: 18, respectively) according to the number of total laparoscopic hysterectomy operations.

Results: In group A, the operation time was significantly longer, bleeding volume was lesser, and hospital stays were shorter than in group B. There was no recurrence in either group. Surgical results among the three groups (C, D, and E) were compared. The operation time for the cases in group E with a small number of surgeries was long and the complications tended to be more in number.

Conclusion: Subjects who underwent laparoscopic surgery showed reduced bleeding volume, shortened hospitalization period, and early recovery. On short-term observation, recurrence was not noted, and the same results as laparotomy surgery were obtained. However, complications associated with low proficiency level were recognized. In laparoscopic surgery, it is desirable not only to acquire the skills, but also undergo training before performing the surgery.