術式別にみた婦人科腹腔鏡下手術における難易度に影響を及ぼす因子の後方視的検討～安全で効率的な腹腔鏡下手術手技習得を目指して～

抄録

Objective: To identify the factors associated with difficulty in performing laparoscopic gynecologic procedures, including hysterectomy, myomectomy, adnexectomy, and cystectomy.

Design: Retrospective study.

Setting: University hospital.

Patients: Six hundred and forty-four patients who underwent laparoscopic surgery for benign gynecologic pathologies at our institution in 2017.

Intervention: Laparoscopic surgery.

Main outcome measures: Factors associated with prolonged operative duration and intraoperative blood loss were reviewed. Patient factors were as follows: age, body mass index (BMI), history of vaginal delivery, history of laparotomy/laparoscopic surgery, adenomyosis/fibroid, uterine weight, diameter of the largest myoma, number of enucleated myoma, diameter of the ovarian cyst, type of the ovarian cyst (endometriotic cyst or others), unilateral/bilateral lesions, adnexal adhesion score, and presence of cul-de-sac obliteration.

Result: In hysterectomy, increased uterine weight, adnexal adhesion score, and a history of laparotomy significantly increased the operative duration and blood loss, while a history of vaginal delivery decreased operative duration. In myomectomy, larger diameter size of the myoma and greater number of enucleated myoma significantly increased operative duration and blood loss, and high BMI increased operative duration. In adnexectomy, adnexal adhesion score significantly increased operative duration and blood loss. In cystectomy, larger diameter size of the ovarian cyst, bilateral lesions, and a presence of cul-de-sac obliteration significantly increased operative duration and blood loss, and high BMI increased operative duration.

Conclusion: Understanding the factors associated with difficulty during laparoscopic gynecologic surgery could be helpful in appropriate case selection by the surgeons depending on their individual technical skills, while ensuring surgical safety.