当科における単孔式腹腔鏡下卵巣嚢腫摘出術の一工夫～ダグラス窩受け皿法について～

抄録

Objective: The protocol for single-port laparoscopic cystectomy (LC) at our hospital includes the preliminary insertion of an isolation bag into the Douglas' fossa to minimize accidental intra-abdominal leakage and tumor cell dissemination secondary to intraoperative rupture of the tumor capsule. The on-bag cystectomy method was introduced in 2016 for cyst removal using an isolation bag. In this study, we retrospectively investigated the usefulness of this technique.

Methods: This study performed at the Saiseikai Senri Hospital between April 2017 and February 2019 included 18 patients who underwent single-port LC performed by a senior resident (with <1 year of experience in laparoscopic surgery). Statistical analysis was performed using the Mann-Whitney U test and the Fisher exact test to compare the operation time, washing time, and estimated blood loss between the conventional and the on-bag cystectomy methods (9 cases each).

Results: No statistically significant intergroup difference was observed in the operation time and the estimated blood loss; however, the cleaning time was significantly shorter in the on-bag cystectomy group. Subgroup analysis of cases revealed that compared with the conventional method, patients who underwent on-bag cystectomy showed a higher rate of left-sided tumors and tumors with a larger diameter and underwent a more technically challenging operation in several cases.

Conclusion: The on-bag cystectomy technique can be learned by beginners in laparoscopic surgery without significantly prolonging the operation time. This approach reduces the risk of tumor cell dissemination and chemical peritonitis by minimizing intra-abdominal leakage and spread of intracystic tumor contents.